ABSITE 2024 deck Flashcards
Absolute CI and relative CI to PV embolization for hypertrophy of liver
overt clinical portal HTN
relative:
- PV tumor invasion
- severe coagulopathy
- uncorrected biliary obstruction/cholestasis
- renal failure
What is preferred site for paracentesis? (if dont have US)
3cm medial and 3cm superior to ASIS (either side, but pick depending on surgical scars etc)
Describe Z0011 trial
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
absolute CI to liver txp
- head bleed
- elevated intracranial pressures
- current or recent extrahep malignancy
- uncontrolled sepsis
- inadequate social/financial support
- prohibitive cardiopulm fxn including R heart strain
Most important predictive factor for survival in RP sarcoma?
tuhmor resectability
followed by histologic grade
which solid organ has the best 1 and 5 year organ specific survival rates?
kidney
liver is second
Patient with TBI - best predictor of longterm outcomes?
motor score of POST-resuscitation GCS
What is tx of C diff?
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
is flagyl safe in pregnant women?
no
utility of IABP
decrease afterload, improve coronary blood flow during diastoleMC
MC indication for IABP
cardiogenic shock after MI
nonspontaneous brown or cheese-like nipple discharge?
MC: mammary duct ectasia
MC benign salivary gland tumors
pleomorphic adenoma (#1 tumor overall)
Warthin’s tumor (males)
MC malignant salivary gland tumors
mucoepidermoid CA
adenoid cystic (indolent, invades nerve roots, very Sn to XRT)
acutely bleeding gastric/esophageal varices - mgmt?
EGD (banding)
octreotide
abx ppx
TBI - best predictor of longterm outcomes?
motor score of POST resusc GCS
“good thing” about robot?
7 degrees of freedom
what do you expect on UA for ATN (in setting of AKI)?
granular or epithelial cell casts
Does hypothermia “contract” (reduce) or prolong effects of anesthetic drugs?
PROLONG, even with mild hypothermia
preferred abx for pancreatic necrosis?
carbapenems (ie erta) preferred; flouroquinolones (CTX), flagyl
vascular supply for -
TRAM flap
lat dorsi flap
sup epigastric
thoracodorsal vessels
which structure is used to guide the perineal dissection?
coccyx (sweep between anus and coccyx … go laterally to ID and divide the levator ani muscles)
what’s tx for merkel cell CA?
-WLE (1-2cm)
-SLNB
-Radiation if …
–primary tumor>/=1cm
–limited surgical margins
–LVI
–Head and neck primary
–Immunocompromised
Standard endoscopes magnify images ___ and digital zoom of ___
30-35x
1.5-2d
radial scar on breast CNB - what do you do?
generally, excisional biopsy (25% malignancy)
pediatric varicocele (kid age <9) with no genital trauma - what’s your thought?
think of a RP mass - US Abd
Treatment for varicoceles?
Most popular surgical: lap varicocele ligation
Acutely unstable patient with cardiac tamponade - best option?
pericardiocentesis
18G needle inserted to left of xiphoid
MC sites of embolic events in LE?
CFA
pop artery
what are boundaries for superficial inguinal LAD?
sartorius (lat)
aductor longus (med)
ing lig (sup)
what does portal triad contain
proper hepatic artery
CBD
portal vein
what is duration of pringle maneuver?
15-20 min at a time, unclamp 5 min
prevent liver ischemia + abscess
how to do witzel jejunostomy?
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
what is a latent error?
hidden failure of organization or system (ie EMR issue)
error of omission vs commission
omission: failure to provide a treatment
commission: doing something wrong (ie prescribing a med when there’s a documented anaphylactic reaction)
patients with HIV - preop workup?
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
neuroblastoma (adrenals) - factors assoc with unfavorable prognosis
- age > 1 year
- N-myc amplific
- LDH
- NSE
appendicitis - what’s psoas sign?
assoc with retrocecal appendix
RLQ pain with passive hip extension
what is howship-romberg sign?
obturator hernia
medial rotation of thigh –> causes pain down anteromedial thigh
can also get loss of adductor reflex (obturator nerve compression)
what’s upper limit of LDH?
280
strongest prognostic indicator for melanoma?
depth
axillary LAD - borders?
medially: SA
lat: ant border of lat dorsi
post: subscapularis
sup: axillary vein
anatomical boundaries of axilla?
(diff from axillary LAD)
apex: post corder of clavicle
ant: pec major/minor
post: subscap
med: SA
lat: ant border of lat dorsi
define Levels I, II, III for ax LAD
Level I: lateral to pec minor
Level II: deep to pec minor
Level III: medial to pec minor
primary fuel for enterocytes?
glutamine
___ can trigger autoimmune diseases
type 1 IFNs
after Ladd procedure, where does cecum and duo go?
cecum in LLQ
duodenum in RUQ
What are Ladd’s bands?
cecum to RUQ
Which assoc with lowest mortality?
-UTI
-resp tract infection
-CLABSI
-intra-abd
-CNS
UTI
MCC sepsis source
resp tract infections
40-50%
(followed by GI and GU)
complement proteins coalesce to form ___
MAC –> bacterial cell wall porosity + cell death
Type A aortic dissection assoc with extension of dissection to __
how to eval this quickly?
R coronary artery –> inferior MI
bedside TTE
when should you use an impella in setting of MI?
cardiogenic shock
first line step for anterior abd stab wound?
local wound exploration
what med causes tinnitus?
lasix
when would digoxin’s side effects be emphasized?
hypoK state (competes with K ions)
__ can accurately differentiate between benign liver masses
MRI
hepatic adenoma is hyperintense on __
T2
1st step in lap R adrenalectomy?
mobilize R triangular ligament to mobilize right lobe of liver
(2nd step: retract liver and expose RP)
transanal hemorrhoidal dearterialization
Doppler guided arterial ligation with hemorrhoidopexy
-sup rectal arteries
-suture proximal to dentate line
pyogenic liver abscess - MC orgs?
e coli
klebsiella
MC presentation of DCIS?
clustered microcalcif on mammo
BCAA
leucine, isoleucine, valine
metabolized in muscle - good for ppl with chronic liver disease
what is innervation of EAS?
pudendal nerves
-inf rectal branch (S2-3)
acute hepatitis - serum sickness - typne of HSN?
3
HSN types
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)
indication for intra-aortic balloon pump
low cardiac output (cardiac index<2.2) or cardiogenic shock
splenectomy for ITP and still sx - next action?
peripheral smear
+HJ bodies = spleen still present = re-explore (not CT)
-HJ bodies = asplenia
HJ bodies=nuclear remnants
late prosthetic graft infection (>4 mo) due to __
early due to __
staph epi (late)
GP
staph aureus (early)
GP cocci, clusters
difference between lean process improvement vs six sigma
six sigma: reduce error/waste
lean: repeatedly revisit and fine tune; outcomes should continue to improve; value stream mapping
features of RP fibrosis
flank or abd pain
newly dx kidney function impairment
fibrosis can encase the aorta - if atypical features, need CT guided bx to exclude malignancy
early stages of wound healing - IL’s?
1, 6, 8
macrophages release them
order of cell arrival for wound healing
platelets
neutrophils
macro’s
lymphocytes
fibroblasts
CNB that sounds like intraductal papilloma - what next?
excisional biopsy
NOT terminal duct excision - that’s if there was no identifiable lesion despite symptoms concerning for papilloma
amplification of __ has worst prognosis in breast cancer
HER2
Steps to sleeve gastrectomy
- devasc greater curvature
- insert bougie (34-40 Fr)
- transect stomach starting at location 2-6 prox to pylorus
- specimen extraction
what makes PID “complicated”?
TOA
pregnancy
failure of outpt mgmt
sarcoma - what makes up grade
mitotic activity
atypia
differentiation
presence/absence of necrosis
how does alvimopan work?
opioid antagonist that blocks binding to mu R
which HPV assoc with anal dysplasia?
HPV 16 and 18
accepted indic’s for damage control surgery
base deficit>15
temp<34 C
pH <7.2
refractory coagulopathy
HD instability
what rate of bleeding can the below detect:
- angiography
- tagged RBC scan
angio: 0.5 mL/min
tagged scan: 0.1 mL/min
lap liver resection indicated for tumors ___ located in ___
<5cm
segments 2,3,4,5,6
MCC anaphylaxis?
NMB agents (roc + succ)
other:
-abx
-opioids
-hemostatic agents
-chlorhexidine
-blue dyes
-NSAIDs
Sx periop anaphylaxis?
Bradycardia, desat, hypotension
Difficulty ventilating
Low end tidal CO2
Rhonchi / flushing / rash / urticaria
Risks of brachial plexus block?
-ptx
-sx diaphragmatic palsy (due to accidental infiltration of phrenic nerve)
how to palliate intractable pain from PDAC?
celiac plexus neurolysis
Blue toe syndrome - cause and tx?
-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)
testicular torsion
chances of viability?
tx if viable after detorsion?
-just bring to OR, don’t waste time with US
-highest chances in first 4-6hr
-tx: b/l orchiopexy
MCC met to lung
CRC
other: prostate, sarcoma
how long dual AP course after DES
min 6 months
pleural effusions caused by TB
straw colored
high protein
high LDH
urine Ca consistent with FHH
urinary Ca < 100mg/24 hr
Ca:Cr clearance ratio < 0.01
what is an endotoxin of gram neg bacteria?
LPS
Which meds have decreased and increased absorption after gastric bypass?
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
which pancreatic enzyme secreted in active form?
lipase
(enterokinase too but that’s from duo, not pancr)
reasons for HD?
AEIOU
acidosis, lytes, intoxication, vol overload, uremia
amiodarone can mess up the ___
liver
how long to wait to do surgery after:
- bare metal stent
- drug eluting stent
1 month
6 months
first signs of local anesthetic systemic toxicity?
dizziness + LH-ness
advance to seizures + respiratory depression
medial pec nerve innervates __
lateral pec nerve innervates __
both pec major+minor
lateral innervates only pec major
most common mesenteric cystic mass? and tx?
cystic lymphangioma
mesenteric cystic mass w/ or w/o septations
tx: complete surgical excision
LCIS on CNB - chance of DCIS/cancer?
10-20%
malignant appearing cells with fried egg appearance?
Paget cells
reasons for anterior midline or other atypical anal fissure?
crohns
syphylis
TB
anal cancer
HIV AIDS
with rectal prolapse, you have ___ rectal capacity?
decreased
pathophysio of duo ulcer?
H pylori (GN helical bacteria) colonization of duo mucosa that has undergone gastric metaplasia
operation for a Siewart type 3 tumor?
2-5cm distal to GEJ
total gastrectomy + distal esophagectomy with LAD
when would you consider EMR for gastric cancer?
-2cm
-well-mod diff
-no submucosal invasion (limited to mucosa)
-no LVI
how do you minimize paraplegia risk after AAA?
maintain adequate prograde perfusion through internal iliac’s
(more common adverse outcome after TAA/TAAA than AAA)
hard vascular signs?
bleeding
bruit or thrill
expanding hematoma
absent pulses (decr pulse = soft sign)
distal ischemia
if FIBTEM MCF is abnormal, what do you give?
If MCF is low, but FIBTEM MCF is normal, what do you give?
cryo
platelets
for CRC anastomoses - what is primary blood flow to rectal remnant?
inf hemorrhoidal artery, from internal iliac
2 common causes of anastomotic leaks
staple failure
tension
optimal tx of neuroendocrine tumor?
- resect primary tumor
- surgical debulking of metastatic disease to <10%
- ppx chole (for octreotide therapy later)
primary tx of hyperCa
NS resuscitation goal UOP >100/hr
(avoid LR)
tx for aldosteronoma?
optimize medically 1st (spironolactone for HTN, low K)
then unilat resection
cyanide poisoning - talk to me
cyanide comes from fire exposure and smoke inhalation
inhibits oxidative phosphorylation by binding to cytochrome C oxidase, blocking MTC
afib in setting of EF<35 - tx?
avoid CCB or BB
instead give amio
Gardner syndrome - 3 things it’s assoc with?
epidermal cysts
GI polyposis
osteomas
MC met to adrenal?
lung
MC vitamin deficiency post-bariatric surgery?
vit D (absorbed in small bowel)
cyclical mastodynia - tx?
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
what is intraop hypothermia assoc with?
- wound infxns
- slower clearance of anesthesia
- worse pain
- coagulopathy
(random: protection against cerebral ischemia)
when is RA iodine rec after thyroid surgery?
*tumor>4cm
*ETE
*postop unstimulated thyroglobulin >5-10
*bulky or >5 +LN
w/u of solid testicular mass?
*US
*tumor markers (AFP, b-HCG, LDH)
*staging CT A/P + CXR
*MRI Brain only if suspicious for brain mets
what is a coloplasty?
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
duo switch - briefly, what is it?
sleeve + bypass, with short common channel (100cm)
what is rigler triad?
pneumobilia
SBO
ectopic calcified gallstone on imaging
what is assoc with high ICP?
Cushing triad (HTN, bradycardia, resp depression)
CN 6 palsy
Incidental meckel’s mgmt
all kids </= 18: resect
males <50: resect
females <50: resect if >2cm, palpable abnormality or assoc fibrous band
adults >49: resect if palpable abnormality
5 year survival after liver transplant for HCC (if follow milan criteria)
65-90%
talk to me about gastric lymphomas
-non Hodgkin’s (DLBCL 55% > MALT lymphoma 40% > Burkitt 3%)
-over 50% present w anemia
-sx: early satiety, bloating
-dx: EGD + bx
-tx: CHOP
Types of prevention:
primordial
primary
secondary
tertiary
quaternary
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)
Merkel cell carcinoma - tx?
WLE, SLNB +/- usually adjuvant radiation if concerning features (>1cm, +LVI, etc)
1-2mm margins to investing fascia
supracondylar fx of humerus - fix? possible complic?
closed reduction + perc pinning (in kids)
Volkmann’s ischemic contracture - splint in flexion and kink neurovasc structures (brachial artery) –> cmpt syndrome –> permanent withered hand
what’s most definitive mgmt of pancreatic duct injury?
ERCP (stent I’m assuming)
side effects of sirolimus?
anemia
thrombocytopenia
HLD
difference bw tacro and cyclosporine
tacro: diabetogenic, alopecia
cyclosporine: hirsutism, gingival hyperplasia
imaging modality of choice for adrenal mass
thin cut multiphase CT
when use endorectal US for CRC cancer?
mid-low rectal cancers below anterior peritoneal reflection
TNF alpha increases __ and __
catabolism and insulin resistance
how does vanco work
block cell wall synthesis
CCA - most common morphology, most favorable histology?
sclerosing or periductal
papillary
when would rib plating be useful?
> 5 fx
b/l rib fx
flail segment
*can reduce ICU LOS and ventilator days (if impaired respi mechanics)
protein C deactivates factors __ and ___
Va and VIIIa
what are major RF for postop respiratory complications?
operative time >2.5 hrs
»> ASA class > 3
»> preop anemia
»> advanced age
painless hematuria + weight loss –> best imaging study?
CT A/P (not US)
enteroccocus
best first line tx for normal enterococcus or VRE?
GP, anaerobic cocci
Unasyn
surveillance for watch and wait (rectal cancer)
every 2-3 months, for 3 yrs:
- DRE
- proctoscopy
- MRI
- CEA
tx for symptomatic or >7cm desmoids?
WLE with frozen section
tx for SBP
cefotaxime + albumin
Frailty Score - is 1 very frail or fit?
1 = most fit
value stream mapping ___
cannot identify errors in the medical care system
it is a visual map to help lean processes and make them more efficient
Six sigma __
identifies and correct root causes of variation
what is urine in pyloric stenosis?
urine ph LOW (excrete H for Na)
Urine Na LOW (reabsorbing Na)
urine K HIGH (excrete K to preserve Na)
cyanosis + low O2 sat - suspect?
metHgb-emia
methylene blue
Bites - which bugs to think of?
pasteurella
human: eikenella
abx: augmentin
PCN allergy: clinda + cipro (or bactrim if pregnant/child)
general TPN req’s
*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
describe c diff
GP anaerobic bacilli
toxin a = enterotoxin
toxin b = cytotoxin (intestinal mucosal inflammation)
highest RF for post op mortality after CABG?
prior heart surgery
what’s other word for Mann Whitney U test?
Wilcoxon rank-sum test
what is TEP
total extraperitoneal
what is TAPP
transabd pre peritoneal
what makes an EC fistula more likely to close?
tract >2cm
smaller defect size
low output (<200/day)
acute etiology (ie - appendicitis, diverticulitis)
no sepsis
well nourished
what is qSOFA score
GCS<15
RR>21
SBP<99
what is purpose of preoperative exam?
identify, quantify, and modify any risk factors
primary source of bilirubin?
senescent RBCs
tx for gonorrhea?
CTX
tx for chlamydia?
doxycycline
what can nitroprusside lead to?
cyanide toxicity
-weakness
-confusion
-pulm edema
thiocyanate>200 –> life threatening
tx: sodium nitrate
antidotes to cyanide toxicity?
sodium nitrite
sodium thiosulfate (this and above usually together)
hydroxocobalamin (1st line)
amyl nitrite (lots of side effects)
tx for spherocytosis?
splenectomy + chole
wait till after age 5
entereg - contraindic?
therapeutic opioid use >7 days
incr risk of MI and GI side effects
what’s metabolic derangement in primary hyperPTH?
hyperchloremic metab acidosis
what does vit C def prevent?
proline hydroxylation (weaker collagen)
MC composition of kidney stone?
Ca oxalate
false + rate of PET for cutaneous melanoma? (for mediastinal malig)
10-20%
pelvic hemorrhage with negative FAST - what are your 3 options?
- IR
- preperitoneal packing
- REBOA into zone 3
Lymphangitis
MC org: strep pyogenes
2nd MC: staph aureus
tx: keflex, ancef, CTX
PCN allergy: clinda, bactrim
Abx for OPSI
IV Vanco and CTX (or cefotaxime)
chylothorax mgmt for:
< 1 L
> 1L
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
person on PD with watery diarrhea and peritonitis - thoughts?
bowel wall erosion (dialysate leaking into bowel)
peritonitis? tx: ex lap
pt with adrenal insufficiency who’s in hospital, hypotensive - what do you do?
dexamethasone –> corticotropin (ACTH) stimulation test + measure basal ACTH –> if low ACTH, low cortisol, then have your dx
change to hydrocortisone + fludrocortisone
Imaging for CCA
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)
“bent inner tube”
volvulus
(coffee bean seems to be sigmoid, usually)
double bubble
duo atresia
high RF for basal cell
> 2cm
immunocompromised
poorly defined
recurrent
what’s a normal phi angle?
<60 degrees
histology of thyroid pathologies
*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
desmoid - pos and neg for?
+vimentin, B-catenin, actin
-cytokeratin, S100
how to tx SBP in a nonseptic patient?
intraperitoneal abx
GP coverage: ancef or vanco
GN coverage: 3/4th gen cephalosporin or aztreonam or aminoglycoside (-micin)
MCC pyogenic liver abscesses
portal vein seeding from
- bowel leakage
- biliary infection
what are degs of hypothermia?
90-94
84-89
<84
which med during resuscitation after cardiac arrest can cause seizures?
sodium bicarb (hyperosmolar/hyperNa state)
efferent loop syndrome
kinking of jejunal limb usually 2/2 herniation posterior to anastomosis
GERD - what is an alarm symptom?
dysphagia
early satiety, continued pain, odynophagia (pain w swallowing)
MC location of mets from
- extremity sarcoma?
-RP sarcoma?
lung
high grade = greater risk of mets
RP sarcomas tend to mets more locoregionally
tx for choledochocele (type III choledochal cyst)?
ERCP w sphincterotomy
CCA risk is too low to warrant morbidity of surgery
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?
ex lap - small bowel injury
short delays increase M&M of SB injuries significantly
VHR - recurrence rate with and w/o mesh?
primary open tissue repair: 30-60%
w/ mesh: 10%
Tumor markers with:
yolk sac tumor
germ cell tumor
epithelial & sex cord stromal tumors
epithelial ovarian
yolk sac : AFP
germ cell : bHCG
epithelial & sex cord stromal : inhibin
epithelial ovarian : CA 125
large (>1.5-2cm), especially sessile polyps - how remove?
piecemeal
sessile - try to use EMR, lift submucosa up
is succ depolarizing or NON depolarizing?
-depolarizing
… so it can result in fasciculations
-nicotinic activation –> can result in bradycardia (via muscarinic stimulation)
-it is metab by plasma pseduocholinesterase
MC site of supernumerary PTH gland? 2nd MC site?
thymus
2nd MC: mediastinum
which c diff toxin causes intestinal necrosis?
toxin A
OR for testicular torsion - what kind of incision?
midline scrotal
appendiceal cancer - when ok to do a simple appy?
appendiceal mucinous neoplasm or NET that is:
<2cm
unruptured
does not involve base
If mucinous adenoCA or worse than above - R hemi
aortic valve - indic for repair / replacement?
valve area < 1 cm sqd
PPI - moa?
IRREV inhibition of H/K ATPase
(parietal cells)
ICA stenosis
<50%
50-69%
>70%
PSV &. ICA:CCA PSV ratio
<125 … <2
125-230 … 2-4
>230 … >4
underlying pathology of post vagotomy dysphagia?
periesophageal fibrosis and lower esophageal denervation (from stripping)
ortho + GI surgery – good indicator for 30 day mortality?
albumin
30 day mortality for EVAR v open AAA repair
1-2% vs 4-5%
operation for SMA syndrome?
duodenojejunostomy
BRCA 1 or 2 mutated + triple neg cancer = which special therapy?
olaparib (PARP inhibitor)
pediatric blunt abdominal trauma - MC hollow viscous injury?
jejunum
then ileum I think
ideal preop diet for bariatric pt?
low carb, high protein, low calorie
(some wt loss, reduce fatty liver)
how to access intrathoracic trachea?
R posterolat thoracotomy
what can tracheal injury result in?
mediastinitis (drainage of secretions into mediastinum)
stenosis if injury is missed
how far must tumor be from CP to do esophagectomy?
> 5cm
MCC late access issues with AVF
intimal hyperplasia at graft-VENOUS anastomosis (later resulting in thrombosis)
indic for adjuvant RADIATION for extremity sarcoma
> 5cm
high grade
close margins
tx of cardiac failure from AVF
med mgmt –> AVF banding –> if that fails, then ligation
wtf is orlistat?
reversibly inhibits pancreatic & gastric lipases (weight loss med)
Indics for resection of rectal carcinoid?
> 2cm
T2 (musc propria) or higher
LVI
high mitotic rate
MCC mortality after blood transfusion
TRALI
treatment of gynecomastia?
liposuction of adipose and surgical excision of glandular tissue
FAP s/p TAC + ileorectal mosis - surveillance?
lower endoscopy annually
upper endoscopy every ?1-3 yrs
timing of preop ppx abx?
1 hr of incision
tx for resectable CRLM
resection + adj 6 mo chemo
macrolides + renal insufficiency
QT prolongation
MC genetic defect in CRC
APC - chrom 5
presence of everted anal crypts = ?
rectal intussusception
what is peripheral femoral nerve palsy
inject local in wrong spot
inability to extend knee
pelvic fx with bleeding in bay .. mgmt?
unstable:
temp responder:
stable:
unstable: ex fix and preperitoneal packing
temp responder: IR
stable: CT
Absolute CI to thrombolysis
active internal bleeding
known intracranial neoplasm
recent trauma, CVA, intra-cranial/spinal surgery (2 mo)
severe uncontrollable HTN
uncontrolled clotting disorder
cystic artery comes off RHA and originates __ to common hepatic duct
POSTERIOR
how to reverse tpa?
cryo
if not available - aminocaproic acid (binds lysine residues)
protamine dose?
1-1.5mg for every 100u heparin
give slow - risk hypotension
tx for lymphangiocarcoma (Stewart Treves)
total mastectomy with or without SLNB. Adjuvent chemo
