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Absite Book > Absite book > Flashcards

Absite book Flashcards

1
Q

MC anaerobe and aerobe for colon cancer

A

anaerobes- bacteroides

aerobes- e coli

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2
Q

E coli toxin

A

endotoxin
LPS lipid A
triggers TNF alpha release

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3
Q

SSI risk by surg class

A

Clean 2%
Clean contaminated 3-5%
Contaminated 5-10%
Gross contaminated 30%

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4
Q

biofilm

A

from staph

exopolysaccharide matrix

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5
Q

what if bacteroides grows from SSI?

A

necrosis or abscess (anaerobe)

implies translocation from gut

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6
Q

MC postop infection –> death, also MC organism

A

pneumonia

staph aureus #1 in ICU (pseudomonas #2)

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7
Q

Line infection organisms

A

1 staph epidermidis #2 staph aureus

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8
Q

Endo v exotoxin

A

E coli has endotoxin

GAS exotoxin

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9
Q

cperfringens toxin

A

alpha toxin

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10
Q

aspergillosis tx

A

voriconazole

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11
Q

SBP bug, protein, wbc, tx

A

low protein, ecoli (strep 2, kleb 3), PMN >500, ceftriaxone

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12
Q

beta lactams- drugs and MOA

A

pcn, cephalosporins, carbapenems, vanco

inhibit cell wall synthesis

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13
Q

30s ribosomal inhibitors

A

tetracyclines
aminoglycosides (-micins)
linezolid

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14
Q

50s ribosomal inhibitors

A

clindamycin

azithromycin (macrolides)

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15
Q

fluoroquinolone moa

A

inhibit DNA helicase

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16
Q

rifampin moa

A

inhibits rna polymerase

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17
Q

peak vs trough dosing

A

peak too high- decrease amount of each dose

trough too high- decrease frequency

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18
Q

Nutrition recs daily by type

A

20% protein (4cal/g) (1g/kg/day)
30% fat (9cal/g)
50% carb (4cal/g)

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19
Q

burns nutrition recs

A

25cal/kg + (30cal x %tbsa)

protein 1 + (3g x %tbsa)

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20
Q

albumin v prealbumin half life

A

18 days albumin

2 days prealbumin

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21
Q

Resp Quotient?

A

CO2 produced to O2 consumed
RQ>1 = too much feed
RQ<0.7 = ketosis and fat oxidation

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22
Q

Refeeding syndrome- electrolyte imbalances

A

decreased K, Mg, PO4

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23
Q

wound healing steps

A

inflamm 1-10d (epithelialization at 1-2mm/day)
proliferation- 5d-3wks (collagen deposition, neovascularization, granulation tissue formation, type III collagen –> type I)
remodeling- 3wk-1yr (collagen cross-linking, but no further collagen production)

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24
Q

wound healing cell type by day?

A

Day 0-2 PMN
Day 3-4 macrophages (release growth factors and shit for healing)
Day 5 + fibroblasts

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25
Q

open vs closed incision healing

A

open- epithelial integrity, dependent on granulation tissue

closed- tensile strength, dependent on collagen deposition and cross linking

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26
Q

when does wound reach max strength?

A

8 weeks (80% original strength)

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27
Q

aortic arch anatomy

A

innominate (becomes right subclav and right common carotid)
left common carotid
left subclav

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28
Q

aortic aneurysm repair indications

A

ascending: >5.5 or >0.5/yr
descending: >5.5 can do endovascular repair, >6.0 open

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29
Q

aortic dissection classifications

A

stanford:
Class A- any ascending
Class B- descending only

DeBakey:
Type I- ascending and descending
Type II- ascending only
Type III- descending only

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30
Q

usual causes of death (3) in aortic dissection?

A

aortic insufficiency –> cardiac failure
cardiac tamponade
rupture

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31
Q

indications for aortic dissection repair

A 
all ascending (open repair only)
descending if with visceral/extremity ischemia or if contained rupture (endograft is option)
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32
Q

artery of adamkiewicz

A

comes of anterior spinal artery ~T9

can be injured during descending thoracic aortic surgery –> paraplegia

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33
Q

what divides ascending and descending aortic dissections?

A

left subclavian

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34
Q

sidedness of liver abscesses

A

amebic, echinococcus, pyogenic usu in right lobe

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35
Q

amebic liver abscess pathophys

A

colonic infection –> liver via portal vein

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36
Q

amebic liver abscess workup and management

A

CT usu, culture will be sterile

flagyl

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37
Q

echinococcus workup and management

A

casoni skin test
CT shows ectocyst (calcified), endocyst (double walled cyst)
perform pre-op ERCP if elevated LFT/bili/cholangitis (check for biliary communication)
albendazole x2 weeks, then surgical removal

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38
Q

schistosomiasis tx

A

praziquantel for liver abscess

can cause variceal bleeding

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39
Q

pyogenic abscess dx and amangement

A 
dx aspirate (usu e coli)
drain and abx
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40
Q

FAP gene and inheritance

A

APC (chromo 5)

auto dom

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41
Q

FAP management

A

prophylactic colectomy at 20
endoscopy q2 yrs for duodenal polyps
lifetime rectal surveillance

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42
Q

Gardner v Turcot

A

both colon CA, APC gene
gardner- desmoid tumors/osteomas
Turcot- brain tumors

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43
Q

lynch syndrome gene and inheritance

A

auto dom

DNA MMR gene

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44
Q

lynch I vs II

A

I- colon CA only

II- also ovarian, endometrial, bladder, stomach

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45
Q

Amsterdam criteria for lynch syndrome

A

3,2,1
3 first degree relatives
2 generations
1 with cancer before 50

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46
Q

lynch syndrome management

A

surveillance colonoscopy at 25 or earlier (10yrs before first primary relative)
do total colectomy at first cancer sx

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47
Q

MC cancer and cancer deaths?

A

women breast
women lung death
men prostate
men lung death

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48
Q

CEA/AFP/CA19-9/CA 125

A

CEA- colon CA
AFP- liver CA
CA 19-9- pancreatic CA
CA 125- ovarian CA

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49
Q 
Tumor markers:
beta HCG?
NSE?
chromagranin A?
Ret oncogene?
A

bHCG- testicular CA, choriocarcinoma
NSE- small cell lung CA, neuroblastoma
Chromagranin A- carcinoid
ret oncogene- thyroid medullary CA

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50
Q

EBV associated malignancy

A

nasopharyngeal CA

burkitts lymphoma

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51
Q 
side effects:
cisplatin
carboplatin
vincristine
vinblastine
A

cisplatin- nephro, neuro, ototoxic
carBoplatin- Bone myelosuppression
vincristine- peripheral neuropathy
vinBlastine- Bone myelosuppression

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52
Q

cyclophosphamide side effects

A 
hemorrhagic cystitis (can be helped with mesna)
SIADH
gonadal dysfunction
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53
Q

sweets syndrome

A

acute febrile neutropenic dermatitis

side effect of GCSF admin (used for neutrophil recovery after chemo)

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54
Q

Li Fraumeni syndrome- gene and cancers

A

p53

sarcomas, breast CA, brain, leukemia, adrenal CA

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55
Q

suspicious axillary node- primary? top3

A

lymphoma #1
breast
melanoma

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56
Q

krukenberg tumor

A

ovarian tumor (met from stomach)

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57
Q

bony mets- MC primaries?

A

breast and prostate

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58
Q

small bowel mets- MC primary?

A

melanoma

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59
Q

induction v neoadjuvant v adjuvant v salvage chemo?

A

induction- chemo only
neoadjuvant- chemo first
adjuvant- chemo later
salvage- when initial chemo doesnt work

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60
Q

empyema phases

A 
exudative phase (1 wk)- chest tube and abx 
fibroproliferative phase (wk 2)- CT and abx, maybe VATS
organized phase (wk 3)- decortication
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61
Q

normal aorta size (Abdom)

A

2-3cm

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62
Q

cause of AAA

A

degen of medial layer

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63
Q

AAA rupture- most likely to rupture where?

A

left posterolateral wall, 2-4cm below renals

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64
Q

when to reimplant IMA with AAA repair?

A

if backpressure <40
prior colonic surgery
stenosis at SMA
inadequate flow to colon

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65
Q

1 cause of death after AAA repair (early and late)?

A

early- MI

late- renal failure

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66
Q

complications of AAA repair

A

impotence (make sure at least one internal iliac has good flow)
MI, renal failure (#1 cause of death, early and late)
graft infection 1%
pseudoaneurysm 1%
atherosclerotic occlusion (MC late complication)
left colon ischemia (bloody diarrhea)

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67
Q

Criteria for EVAR

A 
neck length >15mm
neck diam 20-30mm
common iliac length >10mm
common iliac daim 8-18mm
neck angle <60deg
no calcs, no neck thrombus
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68
Q

endoleak type

A

type I- at attachment sites
type II- collaterals bleeding (observe)
type III- at overlap sites (if using multiple grafts or if graft tears)
type IV- porous graft wall (observe)

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69
Q

inflammatory AAA

A

not infection
10% of AAA
can get adhesions to duodenum, and ureters
thickened rim on CT

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70
Q

mycotic (AAA) aneurysm- bugs, tx

A

salmonella (#1), staph
infection of atherosclerotic plaque
bypass and resection of infected aorta

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71
Q

aortic graft infection bugs and tx

A

staph #1, e coli #2

bypass and resect infected graft

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72
Q

aortoenteric fistula- presentation, location, management

A

> 6mo after surgery (AAA repair)
hematemesis, then blood per rectum
erosion into 3rd/4th portion of duodenum
bypass, resect graft, close duodenal hole

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73
Q

conjoined tendon

A

transversalis and internal oblique

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74
Q

Basssini repair

A

conjoined tendon to inguinal

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75
Q

howship romberg

A

inner thigh pain with internal rotation

obturator hernia sign

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76
Q

desmoid tumor syndromw?

A

gardners (+colon ca)

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77
Q

mesenteric tumors- benign v malignant location, type of malignant common?

A

benign- more peripheral
malignant- closer to root
usu liposarcoma, leiomyosarcoma

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78
Q

RP tumors MC type?

A

lymphoma #1

liposarcoma #2

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79
Q

CO2 embolus tx

A

head down
turn to left
aspirate CO2 through central line

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80
Q

basal cell appearance and path

A

pearly, rolled borders

peripheral palisading nuclei, stromal reaction

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81
Q

basal cell treatment

A

0.3-0.5cm margins

xrt and chemo

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82
Q

squamous cell skin cancer

A

0.5-1.0cm margins
Mohs sx for high risk
xrt chemo

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83
Q

which pain med to avoid in pancreatitis?

A

morphine

can cause sphincter of oddi contraction

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84
Q

indications for cystgastrostomy in pancreatic pseudocyst

A

no resolution with conservative management (3mo?)

growing (maybe resect to r/o cancer)

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85
Q

med for pancreatic fistula or pleural effusion/ascites 2/2 pancreatitis

A

octreotide (decreases secretions)

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86
Q

dx of chronic pancreatitis

A

CT- shrunken pancreas, calcs
ERCP
chain of lakes on imaging

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87
Q

Puestow v frey procedure indicaton

A

puestow- pancreatic duct >8mm

frey- core out if narrow duct

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88
Q

MC cause of splenic vein thrombosis, and tx?

A 
chronic pancreatitis (can cause gastric varices)
tx splenectomy
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89
Q

dx pancreatic insufficiency

A

fecal fat testing

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90
Q

peritoneovenous shunts- indications and contraindications

A

refractory ascites with venous anatomy that precludes TIPS

contraindicated in liver transplant candidates

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91
Q

mc gallbladder ca met?

A

liver (IV and V)

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92
Q

gallbladder ca tx

A

no muscle involved - chole
muscle involved- wedge resectionof seg IVb and V
tumor can implant to trocar sites

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93
Q

improved extracolonic symptoms after proctocolectomy in UC

A

erythema nodosum
uveitis
arthritis

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94
Q

papillary thyroid cancer pathology

A

psammoma bodies

orphan annie nuclei

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95
Q

papillary thyroid cancer managemetn

A

<1cm- lobectomy
>1cm, bilateral lesions, hx of XRT- total thyroidectomy
need radioactive iodine if residual dz

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96
Q

spread of thyroid cancers

A

follicular- hematogenous (MC to bone)

papillary and medullary- lymphatic

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97
Q

follicular thyroid cancer managemetn

A

lobectomy (dx)
if cancer >1cm, need total thyroidectomy
radioiodine if >1cm or extrathyroidal dz

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98
Q

medullary thyroid cancer pathology

A

parafolicular c cells (secrete calcitonin)

amyloid deposition

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99
Q

medullary thyroid cancer- presentation

A

usually diarrhea (secrete calcitonin –> flushing and diarrhea

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100
Q

prophylactic throidectomy for men2a vs men2b

A

2a- at 6yo

2b- at 2yo

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101
Q

radioactive iodine therapy

A

4-6wks after thyroidectomy

for follicular and papillary only

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102
Q

thoraic outlet anatomy

A

subclavian vein between clavicle and first rib, anterior to anterior scalene
subclavian artery and brachial plexus posterior to anterior scalene

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103
Q

symptoms of thoracic outlet syndrome

A

neuro mc (usu ulnar distribution)
tinsels test
venous: effort induced thrombosis (paget von schrotter), give thrombolytics and resect rib
arterial: usu d/t anterior scalene hypertroph, ischemia, adsons test, resection or bypass

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104
Q

CA19-9

CA125

A

CA19-9 pancreatic cancer

CA125 ovarian CA

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105
Q

beta HCG

A

testicular CA and choriocarcioma

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106
Q

NSE tumor marker

A

small cell lung CA

neuroblastoma

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107
Q

chromagranin A

A

carcinoid tumor

108
Q

cisplatin and carboplatin side effects

A

cisplatin- nephrotoxic, neurotoxic, ototoxic

carboplatin- Bone (myelo)suppresion

109
Q

vincristine and vinblastine side effect

A 
vincristine peripheral neuropathies
vinblastine bone (myelo)suppression
110
Q

cyclophosphamide side effect

A 
SIADH
hemorrhagic cystitis (give mesna to help alleviate)
111
Q

Rb1, p53, APC, DCC

A 
all tumor suppressors
Rb1 Chr13
p53 chr 17
APC chr 5
DCC chr18
112
Q

Li Fraumeni

A

p53 defect

sarcomas, breast CA, brain tumors, leukemia, adrenal CA

113
Q

krukenburg tumor

A

stomach tumor or colon tumor (from ovarian mets)

114
Q

Phase I, II, III, IV

A

Phase I: safe and at what dose
Phase II: effective?
Phase III: controlled trial
Phase IV: implement and marketing

115
Q

prognostic indicators for hepatic colorectal mets

A 
disease free interval >12mo
tumor # <3
CEA <200
size <5cm
negative nodes
116
Q

primary mortality periop kidney transplant

A

MI and stroke

117
Q

kidney rejection workup and management

A

duplex ultrasound
biopsy
decrease CSK and FK (these can be nephrotoxic)
pulse steroids

118
Q

MELD score

A

liver transplant vs medical therapy (if >15, transplatn is better)
involves creatinine, INR, bilirubin

119
Q

liver transplant for hep B, how to prevent reinfection?

A

HBIG and lamivudine (reduces reinfection rate by 20%)

120
Q

acute vs chronic rejection of liver transplant

A

acute- first 1-2 months, portal triad lymphocytosis, endotheliitis, bile duct injury (t cell mediated0
chronic (rare)- disappearing bile ducts

121
Q

What does KP transplant fix (and not fix)

A

decreases retinopathy and neuropathy
decreases autonomic dysfunction (gastroparesis)
Does NOT reverse vascular disease

122
Q

1 cuase of early mortality for lung transplant

A

reperfursion injury (similar to ARDS)

123
Q

path for heart or lung acute rejection

A

perivascular lymphocytosis

124
Q

MCC cuase of late mortality for lung transplant

A 
briochiolitis obliterans (chronic rjeectION)
MC cause of death overall
125
Q

trauma hemorrhage- BP when decomp and fluid resus

A

BP ok until 30% body volume loss

2L LR , then give blood

126
Q

DPL positive criteria

A

> 10cc blood, >100,000 RBC/cc, food, bile, bacteria, >500wbc/cc

127
Q

DPL misses?

A

RP bleeds

contained hematomas

128
Q

ER thoracotomy indications

A

Blunt- if pressure lost in ER

penetrating- if pressure lost on the way to ED

129
Q

ED thoracotomy incisions

A

right fourth and fitfth intercostal spaces
clamp descending thoracic aorta (if abdom injury)
open pericardium anterior to phrenic nerve in longitiudinal fashion

130
Q

decreasing ICP

A 
raise HOB
sedation/paralysis
relative hyperventilation (CO2 30-35)
hypertonic saline (Na 140-150)
mannitol
131
Q

C1 and C2 named fractures and management

A 
C1 burst (jefferson)- axial loading (rigid collar)
C2 hangmans (bilateral pedicles)- traction and halo
C2 odontoid- above base = stable, at base (will need fusion and halo), extension into vetebral body (will need fusion and halo)
132
Q

epistaxis management

A

anterior packing

pstieror- may need to embolize internal maxillary artery

133
Q

neck zone borders

A

Zones I- clavicle to cricoid cartilage

zone II- to angle of mandible

134
Q

management of esophageal neck injuries

A 
small- primary clsoure
big neck- place drains
big chest- spit fistula and then esophagectomy later
Neck- left side
upper 2/3 thoracic- right thoracotomy
lower 1/3 thoracic- left thoracotomy
135
Q

chest tube indications for thoracotomy

A

> 1500cc at insertion
250cc/hr for 3 hrs
2500cc/24 hrs

136
Q

diaphragmatic injuries- repair approach

A

transabdominal if <1 week

thoracic if >1 week (will need to take down adhesions)

137
Q

aortic injuries and appropriate incision/approaches

A

median sternotomy- ascending aorta, innominate, proximal right subclav, proxima left common carotid
left thoracotomy- left subclavian, descending aorta
midclavicular incision with clavicular resection- distal right subclavian

138
Q

penetrating box injury

A

clavicles/xiphoid/nipples

need pericardial window, bronchoscopy, esophagogoscopy , barium swallow

139
Q

management of paraduodenal hematomas

A

usu in third portion
if intraop >2cm, open
if found on CT- TPN and NGT, usu cure within 2-3 wks

140
Q

management of duodenal injury

A

try for primary repair
if not, jejunal serosal patch
if not, pyloric exclusion or gastrojejunostomy
distal feeding J and proximal draining J

141
Q

conservative management failure for liver and splenic injury?

A

hypotension or hct <25 after 4 units pRBC for liver, 2units pRBC for spleen

142
Q

hematuria after trauma?

A

get CT scan and IVP if you can

143
Q

extraperitoneal vs intraperitoneal bladder rupture

A

extraperitoneal- just leave foley in for 1-2 weeks

intraperitoneal- need repair

144
Q

urethral tear management

A

large tear- suprpubic cystostomy and repair in 2-3 months

small tear- urethral catheter and repair in 2-3 months

145
Q

kleihauer betke test

A

test for fetal blood in maternal circulation (placental disruption)

146
Q

pressure sore stages

A

I- erythema only
II- partial skin loss
III full thickness (subQ fat)
IV- involves bone and muscle

147
Q

types of melanoma

A

lentigo maligna- least aggressive
superficial spreading- MC
nodular- most aggressive
acral lentiginous- aggressive, african american, soles/palms

148
Q

melanoma thickness and resection margins

A 
<1mm = 1cm margins
1-2mm = 1-2cm margins
>2mm = 2cm margins
149
Q

management of anteiror neck and head melanoma

A

if >1mm - need to do superficial parotidectomy

150
Q

soft tissue sarcoma staging based on?

A

grade (not sz)

151
Q

recurrent laryngeal nerve innervates?

A

larynx (except circothyroid muscle)

superior laryngeal innervates cricothyroid

152
Q

larynx inervation?

A

recurrent laryngeal most

cricothyroid is innervated by superior laryngeal

153
Q

thyrocervical trunk branches

A 
STAT
suprascapular
transverse cervical
ascending cervical
inferior thyroid
154
Q

trapezius flap artery?

A

transverse cervical

155
Q

most common site of oral cavity cancer?

A

lower lip (sun exposure)

156
Q

plummer vinson syndrome

A

glossitis, esophageal web, spoon fingers, IDA

157
Q

naspharyngeal, oropharyngeal, hypopharyngeal SCCA –> nodes?

A

naso and oro –> posterior cervical

hypopharyngeal –> anterior nodes

158
Q

nasopharyngeal, oropharyngeal, hypopharyngeal SCCA- management?

A

naso- XRT only

oro and hypo- XRT if <4cm and no nodes, otherwise XRT + surgery

159
Q

parotid surgery - injured nerve?

A

greater auricular nerve (numb to lower ear)

160
Q

MC salivary gland tumor in kiddos?

A

hemangiomas

161
Q

csf rhinorrhea indicative of?

A

cribriform plate fx

162
Q

peritonsilar abscess vs retropharyngeal abscess vs parapharyngeal abscess?

A

peritonsillar in older kids >10yo
retropharyngeal <10yo, airway emergency
parapharyngeal- dental infections, morbiditiy from mediastinal spread, drain through lateral neck and leave drain

163
Q

ludwigs angina- involved muscle?

A

mylohyoid

usu 2/2 dental ifnection

164
Q

preauricular tumor- most common?

A

parotid
usually benign
mc benign is pelomorphic adenoma

165
Q

head and neck mets to ?

A

lung

166
Q

posterior neck mass is what?

A

lymphom until proven otherwise

get FNA

167
Q

neck mass workup-

A

laryngoscopy and FNA (maybe do abx x2wk trial)
panendoscopy and neck/chest CT
excisional bx

168
Q

benefits of tracheostomy

A

decreased secretions
easier ventilation
decreased pna risk

169
Q

cleft lip v cleft palate management

A

cleft lip- repair at 10wks/10lb/10hgb

cleft palate- repaire at 12mo

170
Q

anterior vs posterior pituitary

A

anterior- ACTH, TSH, GH, LH, FSH

posterior- ADH, oxytocin

171
Q

med to give for pituitary tumor?

A

bromocriptine (dopamine agonist0)

172
Q

acromegaly 2/2 pituitary adenoma- dx, management and mc complication

A

elevated IGF1
octreotide and resection
worry about cardiac symptoms

173
Q

nelsons syndrome

A 
after bilateral adrenalectomy
increased CRH --> pituitary enlargement 
causes amenorrhea and bitemp hemianopia
hyperpigmentation
give steroids
174
Q

sheehans vs waterhouse friedrichsen

A

sheehands- post preg, pituitary ischemia
waterhouse- adrenal gland hemorrhage post meningicoccus infection
both cause adrenal insufficiency

175
Q

adrenal vasculature-

A 
superior adrenal (inferior phrenic)
middle adrenal (aorta)
inferior adrenal (renal)
176
Q

incidentaloma-management

A

urine metanephrines, urine hydroxycorticosteroids, renin/aldosterone levels
Surgery needed if >4cm, nonhomogenous or >10% functioning, <60% washout, enlarging
otherwise follow
also need bx if any cancer history

177
Q

common primary that mets to adrenal?

A

lung CA #1

breast, melanoma, renal ca

178
Q

adrenal cortex layers

A

GFR- salt, sugar, sex
glomerulosa- aldosterone
fasciculata- glucocorticoids
reticularis- androgens

179
Q

21 vs 11 hydroxylase deficiency

A 
21 is MC
both cause congenital adrenal hyperplasia - virilization 
21 is slat wasting --> hypotension
11 is salt saving --> hypertension
both require cortisol for tx
180
Q

RAS pathway

A

renin from JXA of kidneys
angiotensinogen to angiotensin I by renin (in liver)
angiotensin I to II by ACE in lung
angiotensin II causea vasoconstriction and induces aldosterone release from adrenals

181
Q

primary hyperaldosteronism diagnosis

A

salt load suppression test (urine aldosterone will stay high)
aldosterone:renin >20
CT with thin cuts
if nothing on CT, get adrenal venous sampling

182
Q

primary hyperaldosteronism treatment

A

adenoma- adrenalectomy

hyperplasia- medical therapy (spironolactone, CCB, potassium replacement)

183
Q

Cushing syndrome- MC causes

A 
MC pituitary adenoma
#2 ectopic ACTH
#3 adrenal adenoma
184
Q

cushing syndrome workup

A

24hr cortisol urine
low dose dexamethasone test- if low ACTH then adrenal source, if ACTH high pituitary vs ectopic source
high dose dexamethasone - low ACTH pituitary source, high ACTH ectopic source

185
Q

MC causes of hypocortisolism

A

withdrawal from exogenous

MC primary dz = autoimmune (TB wordwide)

186
Q

acute addisonian crisis dx and tx

A 
cosynotropin test (give ACTH and measure urine cortisol which will stay low)
give dex (will not f up your test)
(treat before test confirmation)
187
Q

concerning characteristics of incidentaloma

A

heterogenous
>10 houdsfeld units
<60% washout

188
Q

adrenocortical carcinoma

A

bimodal distribution age
50% functioning
open adrenalectomy
Mitotane for unresectable dz

189
Q

catecholamine production

A

tyrosine –> dopa –> dopamine –> norepi –> epi

epinephrine is only created in adrenal medulla via PMNT (so only adrenal pheo will produce epi)

190
Q

pheo rule of 10s

A 
10% malignant
10% bilateral
10% in kiddos
10% familial
10% extraadrenal (will produce norepi, but no epi)
191
Q

pheo diagnosis

A

initial plasma metanephrine screening
then urine test
then CT and MIBG

192
Q

preop for pheo

A 
volume replacement
alpha blocker (phenoxybenzamine) then beta blocker 
(appropriate dosage = mildly orthostatic or dry nasal mucosa)
193
Q

most common extramedullary pheo?

A

organ of zuckerkandle (near aortic bifurcation)

194
Q

thyroid vasculature

A

superior thyroid a - external carotid
inferior thyroid a- thyrocervical trunk
superior/middle thyroid v - IJ
inferior thyroid- innominate v

195
Q

thyroid storm tx

A

beta blockers

wolf chaikoff effect- high dose iodine, inhibits TSH induced release of T3 T4

196
Q

workup of asymptomatic thyroid nodule

A

FNA
if indeterminate- get radionuclide scan
if hot nodule- PTU/iodine
if cold nodule- lobectomy

197
Q

lingual thyroid vs thyroglossal cyst

A

lingual- in foramen cecum, dysphagia/dyspnea/dysphonia, tx with iodine, resect if this doesnt shrink thyroid
thyroglossal- moves with swallowing, resect

198
Q

side effects PTU and MMA

A

PTU ok for pregnancy

both cause aplastic anemia and agranulocytosis

199
Q

hashimotos vs bacterial thyroiditism, de quervains, reidels

A

hashimotos- autoimmune, lymphocytic infitrate, thyroxine
bacterial- usua after bacterial URI, abx
De quervains- hyperthyroid then hypo, after viral URI, high ESR, steroids
Reidels- woody fibrous, associated with PSC, steroids

200
Q

criminal nerve of grassi

A

off right vagus (which comes of celiac branch)

201
Q

acid secretion from stomach

A 
parietal cells
Vagus --> ach 
G cells --> gastrin 
histamine
Ach/gastrin --> PKC
Histamine --> cAMP --> PKA
202
Q

Secretin

A

inhibits gastrin reelease
(from duodenum)
increases panc relase of bicarb

203
Q

somato statin

A 
aka octreotide
from antrum 
hard stop
decreases gastrin
decreases insulin , glucagon
decreases secretin
204
Q

MMC phases

A 
90min
Phase I- rest
Phase II- GB contraction
Phase III- peristalsis
Phase IV- decel
205
Q

Medial v lateral pec n

A

medial both pec major and minor

lateral- pec minor only

206
Q

Stewart treves

A

lymphangiosarcoma 2/2 chronic lymphadenima

will present as purple nodules 5-10yrs after ax dissection

207
Q

Thoracic duct anatomy

A

right
crosses to left at T4
enters IJ/subclav

208
Q

rectal vascular anatomy

A

superior rectal artery (from IMA)
middle rectal a (internal iliac)
inferior rectal a (internal pudendal)

209
Q

rectal v colon cancer management

A

REctal: preop chemo/xrt if stage II/III
Colon: III, IV postop chemo

210
Q

colorectal cancer staging

A

T1 submucosa
T2 to muscularis propria
T3 to serosa

STage I- T1/T2
STage II- T3/T4
Stage III- N+

211
Q

Gardners vs turcot vs peutz jeghers

A

Gardners- colon + desmoid
Turcot- colon + brain
Peutz Jeghers- polyps + mucocutaneous lesions

212
Q

Bowens dz=

A

SCCA in situ
Imiquimod (topical)
WLE if you have to

213
Q

Heydes syndrome

A

angiodysplasia of colon

association with AS`

214
Q

Zenkers where and management

A 
Killians triangle (cricopharyngeus and pharyngeal constrictors)
Myotomy
215
Q

normal LES location and pressure

A

40cm from incisors

15-25 mmg/hg

216
Q

DES management

A

CCB

217
Q

blood supply s/p esophagectomy

A

right gastroepiploic

218
Q

esophageal leiomyoma management

A

excision (do not bx first)

if >5cm or symptomatic

219
Q

MC salivary gland tumors (malignant and benign)

A

1 mucoepidermoid ca
2 adenoid cystic ca

1 pelomorphic adenoma
2 warthins tumor

220
Q

radical neck dissection involves

A

CN XII, SCM, IJ, submandibular gland

221
Q

freys syndrome

A

auriculotemporal nerve injury

causes gustatory sweating

222
Q

MC hepatic artery variants

A

R hepatic - SMA (20%)

Left- left gastric

223
Q

Kupffer cells

A

liver macrophages

224
Q

hemobilia

A

GIB + jaundice + RUQ pain

areriogram and embo

225
Q

hepatic adenoma v hemangioma v FNH on imaging

A

adenoma- cold on liver scan (no kupffer cells)
FNH- central scar, hot on scan
hemangioma- peripheral to central enhancement
HCC- early arterial enhancement, early washout

226
Q

Cushings triad

A

increased ICP
HTN
bradycardia
Kussmausl respirs

227
Q

ulnar, median, radial n

A

ulnar- intrinsic hand, wrist flexion, sensation to back of hand and digits 4/5
median- thumb, sensation palm, palmar 1/2
radial n- wrist finger extension, sensation to dorsum 1/2

228
Q

volkmans contracture

A

supraconydlar humerus fracture
damage anterio interosseous artery
compartment syndrome
pain with forearm extension in flexor sheat (median nerve affected)

229
Q

ewings sarcoma path

A

onion layering and pseudorossettes

230
Q

MC panc tumors

A

insulinoma MC overall

gastrinoma in MEN1

231
Q

gastrinoma triangle

A

CBD/cystic a junction
neck of panc
third duodenum

232
Q

glucagonoma med tx

A

octreotide

233
Q

pulmonary sequestration- extra and intralobar

A

extralobar- systemic a and v

intralobar- pulmonary v, systemic a

234
Q

TEF classification

A 
A- blind pouch x2
B- proximal fistula
C- distal fistula (most common)
D- fistula x2
E- fistula without esophageal pouch
235
Q

VATER

A

vertebral
anorectal
TEF
radial/renal

236
Q

Cantells pentology

A

omphalocele, cardiac, pericardium, sternum, diaphragm

237
Q

PNMT

A

adrenal medulla

norepi –> epi

238
Q

Pheo 10% rule

A 
bilateral
pediatriac
malignant
MEN
extraadrenal
239
Q

Nelsons syndrome

A

post adrenelectomy

increased acth and msh

240
Q

stsg phasese

A

imbibiation
insoculation
neovascularization

241
Q

melanoma types

A

superficial spreading (MC)
nodular (aggressive)
lentigo maligna
acral lentigimous

242
Q

gastric ulcer types

A 
I- lesser curve
II- lesser curve and duodenum
III- prepyloric
IV_ less curve near cardia
V- NSAID
243
Q

chemo for carcinoid

A

streptozocin
doxorubicin
5fu

244
Q

PTU vs MMA

A

PTU- cretinism and anaplastic anemia

MMA- agranulocytossis, avoid in first trimester

245
Q

papillary vs follicular v medullary cancer

A

papillary- MC, lymphatic spread, psammoma bodies
follicular- hematogenous spread
medullary- lymphatic spread, amyloid on path, parafollicular c cells, gastrin secretion test

246
Q

laryngeal muscle inn

A

superior laryngeal- cricothyroid

recurrent laryngeal

247
Q

osteitis fibros cystica

A

hyperPTH

248
Q

positive DPL

A 
>10cc blood
food
bile
bacteria
>100,00rbc
>500 WBC
249
Q

silvadene- sulfamylon, silver nitrate adverse effects

A

SSD- neutropenia
sulfamylon- acidosis
silver nitrate- hyponatremia hypochloremia

250
Q

seminoma vs nonseminoma

A

seminoma MC, XRT! (chemo if node +)

nonseminoma- express afp and bhcg

251
Q

1 nerve injury CEA

A

vagus

252
Q

atherosclerosis phases

A 
foam cells (fat filled MAC)
fibrointimal lesion (smooth m proliferation)
intimal disurpion and thrombus formation
253
Q

meigs syndrome

A

pelvic tumor __> ascites

254
Q

howship romberg

A

obturator hernia

innerthigh pain with internal rotation

255
Q

petits and grynfelts hernia

A 
petits inferior (iliac crest eternal oblique)
grynfelts superior (12 rib, internal oblique)
256
Q

coag lab for liver failure?

A

PT (VII is shortlest half life)

257
Q

cryo used for

A

vwd
hemophilia A
DIC

258
Q

vwd types

A

I- MC, quantitative, AD, ddavp
II- qualitative, AD, cryo
III- quantitative, AR, cryo

259
Q

heparin antidote

A

protamine

260
Q

aminocaproic acid

A

procoagulant

for DIC and thrombolytic OD

261
Q

digoxin dont use with

A

avoid in hypokalemia (inhibits K/Na pump) will worsen hypokealmiea

262
Q

metyrapone and aminoglutethimide-

A

inhibit cortisol synth (for adrenal hyperplasia tx)

263
Q

respiratory quotient

A

0.7fat
0.8 protein
1.0 carb
<0.7 = ketosis and fat oxidation

264
Q

copper deficiency

A

pancytopenia

265
Q

woundhealing course

A

inflammation- 1-10d (PMN 1-2d, MAC 3-4d)
proliferation 5d-3wks (fibroblasts) (neovasculrariation) granulation, @3wks collagen II–> I
Remodeling (>3wks)- stable collagen amount

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