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Absite Flashcards

1
Q

What is the main nutrition source for colonocytes?

A

Short chain fatty acids - butyric acid

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2
Q

What is the main fuel source for small bowel?

A

Glutamine

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3
Q

What is the primary fuel source for neoplasticism cells?

A

Glutamine

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4
Q

What are the precursors for glyconeogenesis?

A

Alanine, lactate, pyruvate, glycerol

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5
Q

How does fat enter enterocyte?

A

Medium and short chains by simple diffusion

Long chain with micelle

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6
Q

Where does fat go after being absorbed from GI system?

A

Long chain go to lymphatics by thoracic duct

Medium and short chain go to portal system

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7
Q

What cell is the main source of histamine in blood?

A

Basophils

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8
Q

What cell is the main source of histamine in tissues?

A

Mast cells

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9
Q

What is the pathological cause of fever from atelectasis?

A

IL-1 released from alveolar macrophages

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10
Q

Which cells produce TNF?

A

Macrophages

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11
Q

Which cytokine causes fever?

A

IL-1

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12
Q

What is the strength layer in bowel?

A

Submucosa

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13
Q

What are the primary collagens in wound healing?

A

Type III - days 1-2

Type I - days 3-4. All type III collagen replaced by type I by 3 weeks

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14
Q

Which inhaled anesthetic is best for neurosurgery?

A

Isoflurane, lowers brain O2 consumption; no increase in ICP

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15
Q

Which paralytic undergoes Hoffman degradation?

A

Cisatracurium

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16
Q

What do you give for an elevated R time on a TEG?

A

FFP

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17
Q

What do you give for a decreased amplitude on a TEG?

A

If less than 48 mm give platelets

If 48-54 mm give desmopressin

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18
Q

What do you give for decreased alpha angle on a TEG

A

Give cryo until angle is greater than 45°

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19
Q

What do you give for a high LY 30 on a TEG

A

If greater than three percent give TXA

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20
Q

What test confirms hyperaldosteronism?

A

Salt load suppression test, urine aldosterone will be high

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21
Q

What is the aldosterone:renin ratio in hyperaldosteronism?

A

> 20

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22
Q

Where is the only place in the body that makes epinephrine?

A

Adrenal medulla

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23
Q

What is the treatment for unresectable adrenocortical carcinoma?

A

Mitotane

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24
Q

What is the hallmark symptom of Addisonian crisis

A

Hypotension unresponsive to pressors

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25
Q

What is the treatment for nasopharyngeal squamous cell carcinoma?

A

XRT

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26
Q

What are the most common ectopic location for superior parathyroid glands?

A

Retroesophageal space, carotid sheath

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27
Q

When doing 3.5 parathyroid resection for hyperplasia which half do you respect and why?

A

Lateral half because artery comes in medially

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28
Q

At reoperation for missing parathyroid gland, what is most common location the missing gland is found?

A

Normal anatomic position

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29
Q

What is the cause of secondary hyperparathyroidism? What is the treatment?

A

Low Ca and high PTH due to renal failure. Ca supplementation

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30
Q

What is tertiary hyperparathyroidism and what is the treatment?

A

Continued high PTH after renal transplantation. Subtotal parathyroidectomy

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31
Q

What is leriche syndrome?

A

Buttock or thigh claudication due to lesion at aortic bifurcation or above

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32
Q

What is the cause of early <30 days failure of saphenous vein grafts?

A

Technical

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33
Q

What is the cause of intermediate (>30 days <2 years) failure of saphenous vein grafts?

A

Intimal hyperplasia

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34
Q

What is the cause of late saphenous vein graft failure (>2 years)?

A

Atherosclerosis

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35
Q

What is Kawasaki’s vasculitis? And what is the treatment?

A

Medium artery vasculitis. See aneurysm of coronaries. Tx: steroids and CABG

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36
Q

What is the most common cause of failure of AV grafts?

A

Venous obstruction due to intimal hyperplasia

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37
Q

What can you see on angiogram for Buerger’s disease

A

Cork screw collaterals with severe distal disease

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38
Q

What nerve if left undivided after vagotomy can cause persistent high acid levels?

A

Criminal nerve of grassi

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39
Q

Epiphrenic diverticulum is associated with what and what is the treatment?

A

Associated with esophageal motility disorders and treatment is diverticulectomy and myotomy

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40
Q

What is the best test for evaluating if esophageal cancer is resectable?

A

Ct chest and abdomen

41
Q

What is the surgical approach for non-contained esophageal perforations?

A
  1. Longitudinal myotomy to see full extent of injury
  2. Consider intercostal muscle flaps to help cover injury
  3. Drains
42
Q

What is a primary burn caustic injury? How is it treated?

A

Hyperemia. Tx: observation, npo for 3-4 days, may need dilations in the future

43
Q

What is a secondary burn caustic esophageal injury and how is it treated?

A

Ulcerations, educates, sloughing. Tx prolonged observation and conservative management. Esophagectomy for perforation, sepsis or pneumothorax

44
Q

What is a tertiary caustic burn injury to the esophagus and what is the treatment?

A

Deep ulcers, charring, and lumen narrowing. Tx; esophagectomy

45
Q

What is the treatment for budd Chiari syndrome?

A

Tips

46
Q

What is the treatment for amebic liver abscess?

A

Flagyl

47
Q

What is the treatment for hydatid cyst?

A

Albendazole, and surgical removal. Do not spill cyst contents, can cause anaphylaxis

48
Q

What marker is positive in patients with fibrolamellar HCC?

A

Neurotransin tumor marker

49
Q

Which extraintestinal manifestations of UC do not get better with colectomy?

A

Primary sclerosis cholangitis, ankylosis spondylitis

50
Q

What is the most common site of perforation in UC?

A

Transverse colon

51
Q

What’s the most common site of perforation in crohns

A

Distal ileum

52
Q

What is the most common soft tissue sarcoma?

A

Malignant fibrous histiosarcoma

53
Q

What is the work up for soft tissue sarcoma?

A

MRI to rule out vascular, neuro, and bone invasion
Excisional biopsy if <4 cm
Longitudinal biopsy if >4 cm

54
Q

What is a dark nodule on the arm, 5-10 years after surgery and what is the treatment?

A

Lymphangiosarcoma, requires urgent surgery

55
Q

What is the treatment for Paget’s disease of the breast?

A

Mastectomy including nipple areolar complex with snlbx

56
Q

Why should patients with new onset ascites get diagnostic paracentesis?

A

Because 10-25% will have SBP

57
Q

What lab do you not want to order on ascitic fluid?

A

CA-125, it is nonspecifically elevated in ascites

58
Q

Causes of ascites with SAAG greater than 1.1

A 
Cirrhosis
Hepatitis
Vascular obstructions
CHF
Metastasis to liver
Fatty liver disease of pregnancy
Myxedema
59
Q

Causes of ascites with SAAG less than 1.1

A 
Peritoneal carcinomatosis
Nephrotic syndrome
Pancreatitis
Peritoneal TB
Serositis
60
Q

What cancer is associated with caustic esophageal injury?

A

SCC, 40 years later

61
Q

When is bronchoscopy indicated for work up of esophageal cancer?

A

Upper 1/3 to evaluate for tracheal involvement

62
Q

What staging studies are needed for esophageal cancer?

A

Ct chest/abd/pelvis
EUS for depth
Bronchoscopy for lesions in upper 1/3

63
Q

What are the indications for screening MRI for breast cancer

A

Patients with lifetime risk exceeding 20-25%. Population includes strong family history of breast or ovarian cancer, BRCA + or women with first degree relative with BRCA who have not been tested, or mantle radiation for Hodgkins

64
Q

What is the treatment for pleomorphic lobular carcinoma in situ found on core needle biopsy?

A

Excisional biopsy

65
Q

Which veins are effected in Mondors disease

A

Lateral thoracic vein
Thoracoepigastric vein
Superficial epigastric vein

66
Q

Does bilateral mastectomy improve survival rates in BRCA patients?

A

No, but reduces risk of breast cancer by 90%

67
Q

Does bilateral oopherectomy lead to survival benefit in BRCA patients?

A

Yes, and it reduces risk of breast cancer by 50%

68
Q

What are the diagnostic criteria for inflammatory breast cancer

A
  1. Rapid onset of breast erythema, edema, or peau d’orange
  2. Duration of history of no more than 6 months
  3. Erythema occupying at least 1/3 of breast
  4. Histological confirmation of invasive cancer
69
Q

When should patients with FAP start screening?

A

Sigmoidoscopy yearly starting at 13. Surgery should be performed when florid polyposis is detected

70
Q

What are secondary lymphoid organs?

A 
Lymph nodes
Spleen
Peyers patches
Tonsils
Adenoids
71
Q

What is the most common cause of portal vein thrombosis in children?

A

Umbilical vein infection

72
Q

How many lymph nodes are needed for accurate staging of stomach cancer?

A

15

73
Q

What lymph node dissection should be performed for gastric cancer

A

D1 and D2 with distal Pancreatectomy or splenectomy

74
Q

What is intestinal gastric cancer associated with?

A

H pylori

75
Q

What is diffuse gastric cancer related to?

A

Loss of e cadherin mutations and loss of cellular adhesion

76
Q

When should a prophylactic thyroidectomy be performed for patients with MEN 2a? MEN 2b?

A

Before age 1

By age 5

77
Q

At what size nodule Should you consider total thyroidectomy at time omg initial surgery for concern for follicular thyroid cancer?

A

Greater than 4 cm. Would be a T3 lesion

78
Q

What is Bowen’s disease and what is the treatment?

A

Anal intraepithial neoplasia type III.

Treatment is wide local excision with 4 quadrant biopsies to define resection region

79
Q

What is the distance from the anal verge that you can to transanal excision?

A

Less than 6 cm

80
Q

For gastric, esophageal, rectal, and colon cancer what is the T stage for a lesion that invaded the muscularis propria?

A

T2

81
Q

What are the incisions and where is the anastomosis for transhiatal esophagectomy?

A

Cervical incision
Midline laparotomy

Cervical anastomosis

82
Q

What are the incisions and where is the anastomosis for Ivor Lewis esophagectomy?

A

Midline laparotomy
Right thoracotomy

High thoracic anastomosis (above the authors vein) about 3-5 cm lower than transhiatal anastomosis

83
Q

What are the incisions and where is the anastomosis for Mckowen esophagectomy?

A

Midline laparotomy
Right thoracotomy
Neck incision

Cervical anastomosis

84
Q

What is the advantage to performing dissection through right thoracotomy in esophagectomy?

A

Can perform subcarinal lymphadenectomy and ligate the thoracic duct

85
Q

What artery supplies the gastric conduit for esophagectomy?

A

R gastroepiploic artery

86
Q

How do you treat a chyle leak after esophagectomy?

A

Adequate drainage
If output is < 500 cc/day then can treat with npo and Tpn
If output is > 500 cc/day then need to ligate duct

87
Q

Where do you make an incision for aortic injuries?

A

Median sternotomy

88
Q

What incision do you make for right subcalvian injuries?

A

Median sternotomy with right cervical extension

89
Q

What incision do you make for left subclavian vessel injury?

A

Left anterolateral thoracotomy

90
Q

What incision do you make for left carotid artery injury?

A

Median sternotomy with left neck extension

91
Q

What are worrisome features for IPMNs?

A 
Cysts < 3 cm
Thickened cyst wall
MPD size 5-9 mm
Non enhanced mural nodes
Abrupt change in MPD caliber with distal pancreatic atrophy
Lymphadenopathy
92
Q

Pancreatic lesion with ovarian type stroma what is it and what is the treatment?

A

Mucinous cystic neoplasm

Resection

93
Q

What pancreatic lesion causes necrolytic migratory erythema?

A

Glucagonoma

94
Q

What supplement should patients with glucagonoma receive prior to resection?

A

Zinc

95
Q

Which inhaled anesthetic has the least myocardial depression

A

Nitric oxide

96
Q

At what age does AFP return to normal in a new born?

A

9 months

97
Q

What are the three first line medications for treatment of crohns?

A

Sulfasalazine
Mesalamine
Budenosine

98
Q

How many cm are needed between strictureplasty?

A

At least 10 cm

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