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ABSITE Killer > Absite killer plusa > Flashcards

Absite killer plusa Flashcards

1
Q

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What is the source of fever in atelectasis?
A

Alveolar macrophages

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2
Q

What is the first sign of malignant hyperthermia?

A

Increase in end-tidal CO2

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3
Q

What is the treatment for malignant hyperthermia

A

Dantrolene

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4
Q

What is the first muscle to recover from paralytics?

A

Diaphragm

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5
Q

What is the rate-limiting step in cholesterol formation?

A

HMG coA Reductase

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6
Q

Where is angiotensin I converted into angiotensin II?

A

lung

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7
Q

What are the effects of angiotensin II?

A

Vasoconstriction Increases aldosterone (keeps Na, loses K/H in urine)

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8
Q

Describe the anatomy of the vagus innervation of the stomach

A

Left vagus (anterior) gives hepatic branch, Right (posterior) gives celiac branch and ‘criminal nerve of Grassi’

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9
Q

Which cells produce pepsinogen?

A

Chief cells

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10
Q

Which cells produce intrinsic factor?

A

Parietal cells

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11
Q

What are the main stimuli for H+ production in the stomach?

A

Acetylcholine, gastrin, and histamine

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12
Q

What is the mechanism of omeprazole?

A

Blocks H/K ATPase of parietal cell

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13
Q

What is the most common symptom post-vagotomy?

A

Diarrhea (35%)

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14
Q

What is the cause of early (15-30 min) dumping syndrome?

A

Hyperosmotic load, fluid shift causes neuroendocrine response, peripheral and splanchnic vasodilation

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15
Q

What is the cause of late (2-3 hrs) dumping syndrome?

A

Increased insulin with decreased glucose

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16
Q

What are the 3 actions of CCK?

A

1) contract gallbladder

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17
Q

What is the primary stimulus of pancreatic bicarb secretion?

A

secretin

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18
Q

What affects the amount of bicarb in pancreatic secretions?

A

Flow rate: high flow = high bicarb, low Cl. Slow flow allows more HCO3/Cl exchange

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19
Q

Describe the phases of the migratory motor complex

A

Phase I - quiescence; Phase II - acceleration, gallbladder contraction; Phase III - peristalsis; Phase IV - subsiding electric activity; occurs in 90 min cycles

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20
Q

What is the key stimulatory hormone of the MMC?

A

motilin

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21
Q

What drug stimulates motilin receptors?

A

Erythromycin

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22
Q

What is the action of Protein C and Protein S?

A

Protein C degrades active V and VIII. Protein S helps protein C

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23
Q

What is the only clotting factor not made in the liver?

A

Factor VIII (made by reticuloendothelial system)

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24
Q

What is the difference between the three types of Von Willebrand’s Disease?

A

Type I and III have low amounts of vWF, respond to ddAVP Type II is qualitatively poor vWF

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25
Q

What is the only inherited coagulopathy with long bleeding time?

A

Von Willebrand’s Disease (autosomal dominant)

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26
Q

What is the pathophysiology of Glanzman’s thombasthenia?

A

IIb/IIIa receptor deficiency of platelets. Decreased platelet aggregation. Fibrin normally links Gp IIb/IIIa receptors

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27
Q

What is the pathophysiology of Bernard Soulier syndrome?

A

Ib receptor deficiency of platelets. Decreased adherence of exposed collagen. vWF normally links Gp Ib to collagen

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28
Q

What test confirms the presence of von Willebrand Disease?

A

Ristocetin test

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29
Q

What are the three possible treatments for vWD?

A

DDAVP

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30
Q

What is the treatment for hemarthrosis in a hemophiliac?

A

Ice, ROM therapy, Factor replacement Do not aspirate

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31
Q

What are the most common inherited thombophilias?

A

Factor V Leiden

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32
Q

What is the treatment for overdose of thrombolytics?

A

Aminocaproic acid (Amikar) - inhibits fibrinolysis

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33
Q

What are the effects of prostacyclin?

A

Decreased platelet aggregation, vasodilatation, bronchial relaxation

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34
Q

What are the effects of thromboxane?

A

Increased platelet aggregation, vasoconstriction, bronchial constriction

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35
Q

What stimulates B cells to become plasma cells?

A

IL-4

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36
Q

Which complements are anaphylatoxins?

A

C3a, C5a

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37
Q

Which complements make up the membrane attack complex?

A

C5-9

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38
Q

What cells are responsible for immunosurveillance against CA?

A

Natural killer cells

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39
Q

What is the source of histamine in blood?

A

Basophils

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40
Q

What is the source of histamine in tissue?

A

Mast cells

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41
Q

Where does it come from?

A

Lipopolysaccharide A from gram negative bacteria

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42
Q

What does an elevated mixed venous oxygen saturation (SvO2) indicate?

A

>77% - sepsis or cyandide poisoning

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43
Q

What does a low mixed venous oxygen saturation (SvO2) indicate?

A

<66% - decreased CO

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44
Q

What are the four intraabdominal abscess locations?

A

sub-diaphragmatic

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45
Q

What two infections can present within hours post-op?

A

B-strep

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46
Q

What is the mechanism of it’s resistance?

A

Inhibits cell wall synthesis

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47
Q

What is the mechanism of quinolones?

A

DNA gyrase inhibition

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48
Q

What is the mechanism of amphotericin

A

binds sterols to alter fungal cell wall

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49
Q

What antibiotic prolongs neuromuscular blockade?

A

Clindamycin

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50
Q

What are the risks of a blood transfusion?

A

CMV is highest Hep C 1:30-150,000 HIV 1:500,000

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51
Q

What are the vitamin K dependent factors?

A

II, VII, IX, X, protein C + S

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52
Q

Which antibiotics are bacteriocidal, with irreversible binding to 30S ribosome subunit, and resistance due to decreased active transport?

A

Aminoglycosides (gentamicin, neomycin, tobramycin)

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53
Q

What is the only depolarizing neuromuscular blocker used?

A

Succinylcholine

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54
Q

What is an adverse effect of succinylcholine in burn patients?

A

hyperkalemia

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55
Q

What are the effects of reglan (metoclopramide)?

A

Dopamine receptor blocker - Increases LES tone and gastric motility

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56
Q

What is the mechanism of digoxin?

A

inhibits Na/K ATPase to increase calcium in heart

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57
Q

What is the effect of digoxin?

A

Slows AV conduction, inotrope but does not increase O2 consumption

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58
Q

What pressor is most useful in GIB?

A

Vasopressin: reduces splanchnic blood floow, portal flow ~40%. Give with B-blocker to avoid angina

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59
Q

What gastric contents have the highest concentration of K?

A

Saliva (20 meq) > gastric (10 meq) > pancreatic/duodenal (5 meq)

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60
Q

What is the water distribution in a average person?

A

2/3 is intracellular and 1/3 is extracellular (80% of extracellular fluid is interstitial and 20% is plasma)

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61
Q

What drug can reverse adverse effects of steroids on wound healing?

A

Vitamin A

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62
Q

How many kcal/g are in protein, fat, and carbs?

A

Protein: 4 kcal/g

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63
Q

Describe vitamin D synthesis

A

Vit D made in skin, to liver for (25-OH, calcidiol), then to kidney for (1-OH, calcitriol), then active

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64
Q

What is the respiratory quotient?

A

Ratio of CO2 produced to O2 consumed

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65
Q

What is the preferred fuel of the colon?

A

Short chain fatty acids - butyric acid

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66
Q

Describe fat digestion

A

Long chain: Micelles to enterocytes to chylomicrons to lymphatics (to jxn LIJ/SCV); medium and short chain are directly absorbed into portal system with aa’s and carbs

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67
Q

What is the preferred fuel of the small bowel?

A

Glutamine

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68
Q

What is the #1 amino acid in the blood stream?

A

Glutamine

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69
Q

What causes a decrease in glutamine in the blood stream during stress?

A

Glutamine goes to kidney to form ammonium to help acidosis

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70
Q

What vitamin deficiency causes hyperglycemia (relative diabetes) and neuropathy?

A

Chromium

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71
Q

What vitamin deficiency causes perioral rash, hair loss, poor healing, and change in taste?

A

Zinc

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72
Q

What vitamin deficiency causes weakness (respiratory) and encephalopathy?

A

Phosphate (needed for ATP)

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73
Q

What vitamin deficiency causes anemia and neutropenia?

A

Copper

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74
Q

Describe the Cori cycle

A

glucose to lactate, to the liver, to glucose

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75
Q

During starvation, what does the brain use for fuel?

A

ketones from fatty acids (instead of glutamine)

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76
Q

What are the electrolyte concentrations of NS vs LR?

A

Normal saline: 154 meq Na and Cl LR: Na 130, K 4, Ca 2.7, Cl 109, bicarb 28

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77
Q

What two electrolyte abnormalities cause hyperexcitability (increased reflexes, tetany)?

A

Hypocalcemia and hypomagnesemia

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78
Q

How does magnesium affect calcium?

A

Low Mg inhibits PTH, so replace MG if difficulty correcting Ca

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79
Q

What are the phases of the cell cycle?

A

G1 - most variable period; S - DNA replication; G2; M - Mitosis

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80
Q

What phase of the cell cycle is most sensitive to radiation therapy?

A

M - mitosis

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81
Q

What are the recommendations for biopsy of an extremity sarcoma?

A

Excisional if < 4cm, otherwise longitudinal incision (less lymphatic disruption, easier to excise scar if biopsy positive)

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82
Q

What is a complication of bleomycin and busulfan?

A

pulmonary fibrosis

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83
Q

What are the risks of tamoxifen?

A

DVT and Endometrial cancer

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84
Q

What is the treatment?

A

Medullary thyroid cancer

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85
Q

What is a side effect of vincristine and cisplatin?

A

Neurotoxicity

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86
Q

What cells provide wound contraction?

A

Myofibroblasts

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87
Q

What cells are responsible for healing by secondary intention?

A

Myofibroblasts

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88
Q

What is the principal collagen late in scar?

A

Type I

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89
Q

What is the principal collagen in a healing wound?

A

III (this is the collagen of granulation tissue)

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90
Q

What type of collage is low in Ehler-Danlos?

A

III

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91
Q

What is the time frame of collagen production in a wound?

A

Begins day 3, max at day 21, then constant amount but more crosslinking, strength

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92
Q

What is the order of cells to a healing wound?

A

Platelets

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93
Q

What are the effects of TGF-B?

A

stimulates fibroblasts and chemotactic for neutrophils (too much/too long can cause fibrosis)

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94
Q

What is the effect of PDGF?

A

Attracts fibroblasts and increases smooth muscle to speed matrix deposition and collagen formation

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95
Q

What is the main source of TNF?

A

Macrophage/monocyte

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96
Q

What cell does TNF recruit and activate?

A

neutrophils

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97
Q

How does TNF cause wasting/cachexia in cancer patients?

A

Anorexia, glycolysis, and lipolysis

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98
Q

What is batson’s plexus, and what is it’s significance?

A

Valveless vertebral veins that connect to internal vertebral venous plexus

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99
Q

What is Poland’s syndrome?

A

Amastia, hypoplastic shoulder, no pectoralis

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100
Q

What is the treatment?

A

thrombophlebitis of superficial vein of breast. Cord like mass laterally.

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101
Q

Describe the ‘T’ staging of breast cancer

A

T1 = <2cm T2 = 2-5cm T3 = >5cm T4 = skin or chest wall involvement

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102
Q

Describe the ‘N’ staging of breast cancer

A

N1 = ipsilateral lymph nodes (1-3 LN on path) N2 = fixed or matted LN (4-9 LN on path) N3 = infraclavicular, supraclavicular, or internal mammary (>10 LN on path)

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103
Q

Describe the staging of breast cancer according to TNM guidelines

A

Stage I = T1 Stage IIA = T1N1 or T2N0; IIB = T2N1, T3N0 Stage IIIA = T1-3 and N2, or T3N1; IIIB = T4N0-2; IIIC = Any T N3

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104
Q

How does hormone receptor status in breast cancer affect prognosis?

A

ER+PR+ > ER-PR+ > ER+PR- > ER-PR-

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105
Q

What % of DCIS develop invasive cancer?

A

50%

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106
Q

What % of LCIS develop invasive cancer?

A

30-40% (in either breast)

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107
Q

What is the difference pathophysiologically in cancer risk between DCIS and LCIS?

A

DCIS is a precursor to cancer

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108
Q

What % of Phyllodes tumor are malignant?

A

10%

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109
Q

What is the treatment for Phyllodes tumor?

A

Wide local excision, rarely mastectomy. No axillary node dissection necessary (spread is hematogenous, not lymphatic)

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110
Q

What type of cancer is BRCA1 and BRCA2 associated with?

A

BRCA1 - ovarian CA (50%)

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111
Q

What are the indication for RT after mastectomy?

A

>4 nodes

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112
Q

What are absolute contraindications to breast-conserving therapy requiring radiation?

A

Prior radiation to breast/chest wall

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113
Q

What is the #1 cause of blood nipple discharge?

A

Intraductal papilloma - no risk of CA

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114
Q

What is Stewart-Treves syndrome?

A

Angiosarcoma arising from chronic lymphadema, often as a complication after mastectomy. Presents as a purplish mass on arm ~10 yrs s/p MRM

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115
Q

What is the difference between the two types of alveoli?

A

Type I: functional gas exchange

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116
Q

What is the association between the thymus and myasthenia gravis?

A

10% of m.g. have thymomas

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117
Q

Popcorn lesion on CXR

A

hamartoma

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118
Q

What are the indications for CABG?

A

intractable symptoms

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119
Q

What is the treatment for a patent ductus arteriosus

A

Indomethacin - blocks PG production - effective in ~70%

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120
Q

What are the effects of IABP?

A

Augments diastolic coronary blood flow and reduces afterload by inflating during diastole (inflates 40msec before T wave, deflates with p wave)

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121
Q

What electrolytes are actively secreted by the colon?

A

K and HCO3

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122
Q

Describe the blood supply of the rectum

A

Superior rectal artery off IMA

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123
Q

What are the most common genetic mutations in colon cancer?

A

p53 (85%), DCC (70%), ras (50%)

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124
Q

Amsterdam criteria

A

3 1st generation relatives, over 2 generations, 1 diagnosed before age 50

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125
Q

Gardner’s syndrome

A

colon CA and desmoid tumors

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126
Q

Turcot’s syndrome

A

colon CA and brain tumors

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127
Q

Peutz Jeghers

A

polyposis and mucocutaneous pigmentation; increased risk of GI, gonadal, breast cancers

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128
Q

What gene is associated with sacroiliitis in IBD?

A

HLA B27

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129
Q

Where are most anal fissures located?

A

posterior midline, 10% are anterior in women

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130
Q

What are the causes of anal fissures which are lateral or recurrent?

A

IBD, TB, or syphilis

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131
Q

What is normal LES tone and length?

A

15-25 mm Hg, 4cm long, 40cm from incisors

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132
Q

What is the treatment of diffuse esophageal spasm?

A

calcium channel blockers

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133
Q

What is the pathophysiology of achalasia?

A

Decreased ganglion cells in Auerbach’s plexus, absence of peristalsis and esophageal dilation. High LES pressures

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134
Q

What is main arterial supply to stomach when used to replace esophagus?

A

right gastroepiploic artery

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135
Q

What is the treatment of esophageal leiomyoma?

A

If symptomatic or >5cm excise by enucleation via thoracotomy (R if middle, L if lower esophagus) Do not biopsy on EGD

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136
Q

What is Killian’s triangle?

A

A potentially weak spot where a pharyngoesophageal diverticulum (Zenker’s) is more likely to occur. Posterior triangular area in the pharynx between the inferior constrictor and the cricopharyngeus muscle

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137
Q

What is a painless mass on the roof of the mouth?

A

Torus - bony exotosis, midline of palate

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138
Q

Which has a greater risk for cancer, leukoplakia or erythroplakia?

A

Erythroplakia

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139
Q

What is the general treatment for different stages of head and neck SCCa?

A

Stage I+II(up to 4cm, no nodes) Rx with single modality (surgery or RT) Stage III+IV get combined modality

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140
Q

What is the treatment for glottic Ca?

A

If cords not fixed, then RT If cords fixed, need surgery and RT

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141
Q

What is the most common type of lip cancer?

A

Epidermoid carcinoma. Lower > upper due to sun exposure

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142
Q

What is the usually presentation of nasopharyngeal carcinoma?

A

50% presesnt late (as neck mass). Drain to posterior neck nodes. A/w EBV

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143
Q

What is the treatment of lip cancer?

A

Resect, primary closure if <1/2 of lip, otherwise flaps. Radical neck dissection if node+

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144
Q

What is Plummer-Vinson syndrome? What type of cancer is increased?

A

Triad of dysphagia (due to esophageal webs), glossitis, and iron deficiency anemia. Increased risk of esophageal/tongue Ca

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145
Q

What are the most common malignant salivary gland tumors?

A

1 - Mucoepidermoid carcinoma #2 - Adenoid cystic carcinoma (#1 of submandibular and minor glands)

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146
Q

What are the most common benign salivary gland tumors?

A

Pleomorphic adenoma (#1 overall), Warthin tumor

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147
Q

What is the treatment for a benign salivary gland tumor?

A

Superficial parotidectomy (spare CNVII). If malignant, take whole parotid. If high grade, need radical neck dissection

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148
Q

What is the difference between a radical neck dissection and a modified radical neck dissection?

A

Radical neck takes CN XI, SCM, IJ. Modified spares some combination of those structures (CN XI is most morbid)

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149
Q

What is the cause of unilateral nasal obstruction and recurrent epistaxis in a teen male? What is the treatment?

A

Juvenile Nasopharyngeal Angiofibroma - benign but locally agressive vascular tumor of nasal cavity. Embolize (internal maxillary artery), then extirpate

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150
Q

What is a replaced right or left hepatic artery?

A

Replaced right - originating off SMA (occurs in 17%) Replaced left - originating off left gastric (occurs in 10%)

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151
Q

What are Kupffer cells?

A

Specialized macrophages in the liver responsible for clearing portal blood and immunosurveillance. Also responsible for early alcohol-induced liver injury.

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152
Q

Describe the anatomical relationship of the Portal triad

A

Portal vein posterior to CBD (on R) and hepatic artery (on L)

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153
Q

What is the #1 cause of benign biliary stricture?

A

Iatrogenic (lap chole)

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154
Q

What are the symptoms and treatment of cholangitis?

A

Fever, RUQ pain, jaundice, +/- hypotension, MS changes. Needs immediate IV Abx, IVF, emergent decompressions/drainage of CBD

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155
Q

What is the treatment of gallbladder adenocarcinoma?

A

Cholecystectomy adequate if confined to mucosa. If grossly visible tumor - regional lymphadenectomy, wedge segment V, skeletonize portal triad

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156
Q

What is the triad of hemobilia?

A

UGIB, RUQ pain, and jaundice - caused by fistula between biliary duct and hepatic arterial system

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157
Q

What is the treatment of hemobilia?

A

workup and treatment with arteriogram

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158
Q

How does the gallbladder concentrate bile?

A

Active absorption of Na, Cl (H20 then follows)

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159
Q

What is the treatment for hepatic adenoma?

A

Hepatic adenoma is an indication for resection 10% rupture/bleed + malignant potential

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160
Q

What is the treatment for hepatic hemangioma?

A

Do nothing unless giant or symptomatic/consumptive

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161
Q

What is Kasabach-Merritt syndrome?

A

Consumptive coagulopathy or CHF due to hemangioma - usually in infants.

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162
Q

What is the treatment of liver amebic abscess?

A

metronidazole, not surgical

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163
Q

What is the treatment of hydatid cysts?

A

Surgical resection with chemotherapy before and after (albendazole or mebendazole)

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164
Q

What is the work-up of hydatid cysts?

A

Casoni skin test + Indirect hemagglutination

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165
Q

What are the main risk factors for hepatocellular carcinoma?

A

Alcoholism, Hep B+C, hemochromatosis, PBC, aflatoxin, alpha-1-antitrypsin deficiency - PBC and Wilson’s are not risk factors

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166
Q

What type of HCC has best prognosis?

A

Fibrolamellar

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167
Q

What is the difference between these types of peripheral nerve injuries: neuropraxis, axonotmesis, neurotmesis?

A

Neuropraxis - focal demyelination, improves Axonotmesis - loss of axon continuity (nerve and sheath intact). Regen 1mm/day Neurotmesis - loss of nerve continuity, surgery required for nerve recovery

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168
Q

What triggers ADH release?

A

Produced when high osmolarity is sensed at supraoptic nucleus of hypothalamus

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169
Q

What is Diabetes Insipidus?

A

Alcohol and head injury inhibit ADH release - high UOP, low urine SG, high serum osmolarity/Na

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170
Q

What is SIADH?

A

Increased ADH release most often by head trauma/tumors or SCLC. Oliguria, high urine osmolarity, low serum osmolarity/Na

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171
Q

What is the effect of ADH?

A

Causes increased free water absorption at the distal tubules and collecting ducts and increases peripheral vascular resistance

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172
Q

What is cerebral perfusion pressure?

A

Mean Arterial Pressure (MAP) - Intracranial Pressure (ICP)

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173
Q

What is Cushing’s triad?

A

Hypertension, bradycardia, and Kussmaul respirations (slow, irregular) associated with increased ICP

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174
Q

Describe the Glasgow Coma Scale ratings

A

Motor: 6 commands, 5 localizes, 4 withdraw pain, 3 flexion, 2 extension, 1 none Verbal: 5 oriented, 4 confused, 3 inappropriate, 2 incomprehensible, 1 none Eyes: 4 spont, 3 command, 2 pain, 1 none

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175
Q

What are the signs of spinal shock?

A

Hypotension with bradycardia, warm perfused extremities (vasodilation) Cord injury above T5

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176
Q

What are the deficits in anterior spinal artery syndrome?

A

Lose bilateral motor, pain, and temperature. Keep position sense, light touch

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177
Q

What is Brown-Sequard syndrome?

A

Spinal cord hemi-transection Lose ipsilateral motor, contralateral pain and temperature

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178
Q

What is Central Cord Syndrome?

A

Acute cervical spinal cord injury characterized by bilateral loss of upper extremity motor, pain, and temperature; legs relatively spared. Often due to hyperextension

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179
Q

What are the indications to operate on a skull fracture?

A

If open or depressed

180
Q

What are the effects of L3-L4 disc herniation?

A

L4 root compresson - quadriceps, week knee jerk

181
Q

What are the effects of L4-L5 disc herniation?

A

L5 root compression - foot drop, possible big toe hyperesthesia

182
Q

What are the effects of L5-S1 disc herniation?

A

S1 root compression - weakness in plantar flexion (pushing off toes), weak ankle jerk, hyperesthesia lateral foot/calf

183
Q

What is the terrible triad of O’Donaghue?

A

lateral blow to knee - injury to ACL, MCL, medial meniscus

184
Q

What does the medial nerve do?

A

thumb apposition, sensation to most of palm, 1st 2 1/2 fingers (carpal tunnel)

185
Q

What does the ulnar nerve do?

A

intrinsic musculature of hand, finger abduction, wrist flexion, sensation to 2 1/2 fingers/back of hand

186
Q

What does the radial nerve do?

A

Wrist/finger extension, sensation to back of lateral hand; no motor in hand

187
Q

What are the benefits of early ORIF in femur fracture?

A

early mobilization

188
Q

Which types need open procedures?

A

fracture that involves the epiphyseal plate or growth plate of a bone Types III, IV, V are intra-articular and thus need open repair

189
Q

What are the signs of hip dislocation?

A

Posterior (90%) - internal rotation, flexed, abducted thigh Anterior - frog leg (external rotation, abduction)

190
Q

What three fractures are prone to compartment syndrome?

A

Calcaneous, tibia, supracondyle of humerus

191
Q

What is treatment of knee dislocation?

A

Most texts say arteriogram all posterior, but at least some vascular assessment (ABI/CT angio/duplex US) is necessary to evaluate popliteal injury even in the presence of normal vascular assessment

192
Q

What nerve is commonly injured in shoulder dislocation?

A

axillary nerve in anterior dislocation (90% of dislocations)

193
Q

What is the treatment?

A

Permanent flexion contracture of the hand at the wrist.

194
Q

What does a tender snuffbox indicate?

A

Navicular fracture - even with negative XR, requires cast up to elbow

195
Q

What is the treatment?

A

Progressive proliferative of palmar fascia causing flexion contracture of fingers of hand, unknown exact cause (trauma, DM, EtOH, epilepsy) Treatment with steroids, physical therapy, but may need fasciotomy

196
Q

What is the treatment?

A

proximal ulnar fracture with radial head dislocation

197
Q

What is a sunburst pattern on x-ray suggest?

A

Osteogenic sarcoma

198
Q

What does ‘onion layering’ on x-ray suggest?

A

Ewing sarcoma

199
Q

What do pseudorosettes on path suggest?

A

Ewing sarcoma

200
Q

Treatment?

A

Double bubble on x-ray. Prone to pancreatitis, possible obstruction. Treat obstruction with duodenojejunostomy, do not resect pancreas

201
Q

What is effective pain relief for non-resectable pancreatic CA?

A

Celiac plexus block (50% EtOH on both sides of aorta near celiac)

202
Q

What is treatment of pancreatic pseudocyst?

A

Expectant management initally - 85% resolve on their own If persistent and symptomatic - internal drainage by cyst-gastrostomy, -duodenostomy, or -jejunostomy

203
Q

Treatment?

A

Whipple’s triad (symptoms of hypoglycemia, glucose <45, improvement with glucose) Insulin to glucose ratio >0.4 Increased C-peptide Rx = enucleation (though 90% are benign)

204
Q

What are the boundaries of the gastrinoma triangle?

A

(1) cystic/CBD junction

205
Q

What are the signs of gastrinoma?

A

Severe ulcer disease, diarrhea (lipase destruction by acid, malabsorption, incr secretion)

206
Q

What test evaluates gastrinoma?

A

Secretin stimulation test - normal patients will decrease gastrin

207
Q

What are the symptoms of a somatostatinoma?

A

gallstones

208
Q

Treatment?

A

diabetes

209
Q

What are the symptoms of VIP-oma?

A

WDHA syndrome = watery diarrhea hypokalemia achlorydia

210
Q

What is the treatment for a choledochal cyst?

A

Must excise, leaving cyst increases cancer, pancreatitis, and cholangitis risks Transplant if type IV or V

211
Q

What are the types of choledochal cysts?

A

I - (>90% of cysts) dilatation of CBD (part or whole)

212
Q

Treatment?

A

mass of non-functioning primitive tissue in the lung

213
Q

What is the #1 presentation of pulmonary sequestration?

A

infection

214
Q

What is the cause of respiratory distress at birth, and massive hyperinflation of a single lobe of the lung? What is the treatment?

A

Congenital lobar emphysema Rx: lobectomy, excellent prognosis

215
Q

What is the first sign of CHF in children?

A

hepatomegaly

216
Q

What is the treatment for a strawberry hemangioma

A

observation - most involute by age 7

217
Q

What is the #1 pediatric malignancy overall?

A

leukemia

218
Q

What gene is neuroblastoma associated with?

A

N-myc

219
Q

What is elevated in neuroblastoma?

A

VMA - Vanillyl mandelic acid

220
Q

What is the treatment for biliary atresia?

A

Kasi procedure - hepatoportoenterostomy - before age 3 months

221
Q

What is the #1 cause of painless GIB in children?

A

Meckel’s diverticulum

222
Q

What is the embryologic origin of a Meckel’s diverticulum?

A

Persistent omphalomesenteric duct

223
Q

What is the treatment of intussusception in children?

A

air/contrast enema (max 120mm Hg)

224
Q

What is the cause of intestinal atresia?

A

Intra-uterine vascular events

225
Q

What is the surgical treatment for malrotation?

A

Ladd’s procedure - appendectomy, take down bands, counterclockwise rotation

226
Q

What is a cystic hygroma? What is the most common location?

A

lymphangioma - left posterior triangle of neck

227
Q

What is the treatment for a thyroglossal duct cyst?

A

Sistrunk procedure - en bloc excision of cyst (midline) with hyoid bone (there is a risk of malignant degeneration of thyroid tissue in cyst)

228
Q

What is the #1 complication of cystic hygroma?

A

infection

229
Q

What is the treatment for a Wilm’s tumor?

A

nephrectomy (80% cure)

230
Q

What is the most common type of tracheo-esophageal fistula?

A

Type C - blind esophagus, distal TE fistula. Spit up feeds, NGT won’t pass

231
Q

What other abnormalities can a patient with a tracheoesophageal fistula have?

A

VACTERL - vertebral, anal atresia, cardiovascular, TEF, esophageal atresia, renal, limb defects - structures derived from embryonic mesoderm

232
Q

What is the #1 cause of a colon obstruction in a newborn?

A

Hirschsprung disease - no BM in first 24 hrs, diagnose with rectal bx

233
Q

What is the treatment for a meconium ileus?

A

Gastrograffin enema - diagnostic and therapeutic

234
Q

How does necrotizing enterocolitis in a newborn present?

A

After initiating feeds in a neonate (premie) in the 2nd or 3rd week of life with blood in the stool OR free air/peritonitis/acidosis Classic triad: abd dist, bloody stools, pneumatosis

235
Q

What is the treatment for imperforate anus?

A

If low - anoplasty If high (meconium in urine, fistula to bladder, vagina, or urethra) - need colostomy

236
Q

What are the characteristics of gastroschisis?

A

Congenital abd wall defect, intrauterine rupture of umbilical cord, no associated defects, lateral (right) defect, no sac

237
Q

What are the characteristics of omphalocele?

A

midline defect, may contain liver or other non-bowel contents, frequent anomalies, has peritoneal sac.

238
Q

What converts norepinephrine to epinephrine?

A

PNMT - Phenylethanolamine N-methyltransferase

239
Q

What are the common characteristics of a pheochromocytoma?

A

10% are: malignant, bilateral, in children, part of MEN, extra-adrenal

240
Q

What is the most common extra-adrenal location for a pheochromocytoma?

A

Organ of Zuckerkandl at aortic bifurcation

241
Q

What is the pre-operative management for a pheochromocytoma?

A

alpha-blockers first, then beta-blockers if tachycardic

242
Q

How is the diagnosis of pheochromocytoma made?

A

screen with urine metanephrines, VMA; MIBG can localize

243
Q

What is Nelson’s syndrome?

A

rapid enlargement of a pituitary adenoma that occurs after bilateral adrenalectomy (10%) - incr ACTH, muscle weakness, pigmentation, vision changes

244
Q

What is Waterhouse Friderichsen syndrome?

A

adrenal hemorrhage a/w meningococcal sepsis

245
Q

What is Conn’s syndrome?

A

hyperaldosteronism = 80% adenoma, 20% bilateral hyperplasia - HTN, low K, high Na

246
Q

What is Addison’s disease?

A

low aldosterone and glucocorticoids = low Na, high K, hypoglycemia. Crisis presents similar to sepsis with hypoTN, fever; steroids are diagnostic and therapeutic

247
Q

What is the most common cause of congenital adrenal hyperplasia?

A

21-hydroxylase deficiency

248
Q

What is Cushing’s disease?

A

Excessive secretion of ACTH from the anterior pituitary, usually from a pituitary adenoma. Causes 70% of non-iatrogenic Cushing’s syndrome.

249
Q

What is the most common cause of Cushing syndrome?

A

iatrogenic

250
Q

What is Cushing’s syndrome?

A

hormone disorder with high levels of cortisol - symptoms include characteristic weight gain (truncal obesity, moon face, buffalo hump), purple striae, hirsutism, polyuria, htn, insulin intolerance

251
Q

How do you determine the type of Cushing syndrome?

A

Dexamethasone suppresion test: Pituitary - high ACTH, cortisol suppressed with steroids Adrenal - low ACTH, not suppressed Ectopic - high ACTH, not suppressed

252
Q

What hormones does the anterior pituitary secrete?

A

GH, ACTH, TSH, LH, FSH, Prolactin

253
Q

What hormones does the posterior pituitary secrete?

A

ADH, Oxytocin

254
Q

What is the classic vision change with pituitary mass effect?

A

Bitemporal hemianopsia - vision missing in outer half of both right and left visual fields

255
Q

What are the symptoms?

A

Prolactinoma - galactorrhea, irregular menses

256
Q

What is Sheehan syndrome?

A

postpartum lack of lactation and persistent amenorrhea caused by necrosis of pituitary from blood loss during/after childbirth

257
Q

What is the treatment for a prolactinoma?

A

Bromocriptine or transphenoidal resection

258
Q

What is the pathophysiology of hidradenitis?

A

involves apocrine glands, thus seen after puberty

259
Q

What are the three steps to the healing of a skin graft?

A

Imbibition, inosculation, revascularization

260
Q

What is the most common cause of flap necrosis?

A

venous thrombosis

261
Q

What type of cancer demonstrates ‘peripheral palisading’ of nuclei and ‘retraction artifact’

A

Basal cell carcinoma

262
Q

What are the common sites for melanoma?

A

Skin > eyes > rectum #1 skin site for men = back, women = legs Worse prognosis on ‘BANS’ - back arms, neck, scalp

263
Q

What type of scar extends beyond margins: keloid or hypertrophic?

A

keloid

264
Q

What is the cause of keloid scar?

A

failure of collagen breakdown and increased collagen production

265
Q

What are the four major types of melanoma?

A

superficial spreading (most common), nodular, lentigo maligna, acral lentiginous

266
Q

What is the Breslow classification of melanoma?

A

<0.75 mm (90% cure)

267
Q

What type of melanoma has the best prognosis? worst prognosis?

A

best = lentigo maligna; worst = nodular

268
Q

What are the surgical margins for resection of a melanoma?

A

in situ = 0.5-1 cm margin

269
Q

What is MALT a precursor to?

A

gastric lymphoma - regresses with H. pylori treatment

270
Q

What are the types of gastric ulcers?

A

Type I - lesser curve/body Type II - 2 ulcers (lesser curve and duodenum) Type III - prepyloric (w/i 3 cm) Type IV - high lesser curve/proximal Type V - anywhere a/w NSAIDS

271
Q

What is the association between gastric ulcers and blood type?

A

Type I = blood type A; Others = type O

272
Q

What margins are necessary for gastric cancer resection?

A

5-6cm due to intramural microscopic spread and extensive lymphatics around stomach

273
Q

What are the effects of a terminal ileum resection?

A

Decreased bile salt absorption -> less colonic H20 absorption -> diarrhea; Decreased B12/intrinsic factor absorption; Decreased binding of oxalate -> oxalate absorbed in colon -> more oxalate stones

274
Q

What are the symptoms of carcinoid syndrome?

A

flushing, diarrhea, asthma, R sided heart valve dz

275
Q

What is the test for carcinoid syndrome?

A

urinalysis for 5-HTP (secreted by foregut), 5-HIAA, and serotonin

276
Q

What factors prevent a fistula from healing?

A

FRIENDS - foreign body, radiation, IBD, epithelization, neoplasm, distal obstruction, sepsis/infection

277
Q

What chemotherapy agents are used for carcinoid tumors?

A

Steptozocin, doxorubicin, 5 FU

278
Q

What is the surgical treatment for a crohn’s patient with multiple strictures?

A

Do not do resection (to avoid short gut) do stricturoplasties

279
Q

What % of patients with carcinoid tumors get carcinoid syndrome?

A

9% - mostly those with extensive mets to the liver

280
Q

What cells produce calcitonin?

A

parafollicular C cells - derived from neural crest cells

281
Q

What is the effect of propylthiouracil (PTU)?

A

Peripherally and centrally blocks conversion of T4 to T3

282
Q

What are side effects of PTU?

A

crosses placenta - cretinism, agranulocytosis, and liver damage

283
Q

What drugs peripherally block conversion of T4 to T3?

A

PTU, Propanolol, Prednisone (& other steroids) and methimazole

284
Q

What is the Wolk Chaikoff effect?

A

Reduction in thyroid hormone levels after a large ingestion of iodine - useful in thyroid storm

285
Q

What is the main limitation of FNA in a solitary thyroid nodule?

A

Differentiation of benign vs malignant follicular and Hurthle cell neoplasms

286
Q

What do Psammoma bodies bodies on the pathology of an FNA of a thyroid suggest?

A

Papillary thyroid cancer

287
Q

What is the most common type of thyroid cancer?

A

Papillary

288
Q

What % of papillary cancer present with positive nodes?

A

20% of adults, 80% of children

289
Q

What is the population distribution of papillary thyroid cancer?

A

F:M ratio is 3:1

290
Q

What does amyloid on FNA of a thyroid suggest?

A

Medullary thyroid cancer

291
Q

What gene is associated with medullary thyroid cancer?

A

ret proto-oncogene

292
Q

What % of patients with medullary thyroid cancer have MEN2?

A

20% (tend to be bilateral, younger, worse prognosis)

293
Q

What is the first step in work-up of thyroid nodule after H&P?

A

FNA

294
Q

What are the limitations of treatment of thyroid cancer during pregnancy?

A

No radioactive iodine during pregnancy or breast-feeding; Operate in second trimester if possible

295
Q

What does the superior laryngeal nerve innervate?

A

motor to cricothyroid muscle (projection and high pitch), sensory to supraglottis

296
Q

What does the recurrent laryngeal nerve innervate?

A

All muscle of larynx except cricothyroid

297
Q

What is the embryologic origin of the parathyroids?

A

Superior from 4th pharngeal pouch, inferior from 3rd; both receive blood supply from inferior thyroid artery

298
Q

What electrolyte abnormalities are present in primary hyperparathyroidism?

A

Elevated calcium, low phosphate

299
Q

What disease is associated with osteitis fibrosa cystica?

A

hyperparathyroidism

300
Q

What % of patients with hyperparathyroidism have a single gland adenoma?

A

85%

301
Q

What is MEN I?

A

Wermer’s syndrome - parathyroid, pancreas, pituitary (prolactinoma most common)

302
Q

What is MEN IIa?

A

Sipple syndrome - Parathyroid, adrenal (pheochromocytoma), and thyroid

303
Q

What is MEN IIb?

A

Thyroid, adrenal, mucosal neuromas/marfan

304
Q

What type of cell mediates graft vs host disease?

A

T cells

305
Q

What causes hyperacute rejection?

A

pre-formed antibodies

306
Q

What test can identify patients who will develop hyperacute rejection?

A

Crossmatch

307
Q

During what timeframe is acute rejection at highest risk to occur?

A

1 week to 3 months

308
Q

What is the mechanism of chronic rejection?

A

Fibrosis of blood vessels of transplanted tissue - loss of blood supply

309
Q

What is the mechanism of acute rejection?

A

Due to HLA mismatch, lymphocytic activation by foreign MHC antigens of graft cells

310
Q

Which risk is higher in patients on immunosupression: viral or bacterial infection?

A

Viral > bacterial because immunosuppression is largely cellular and not humoral

311
Q

What is the #1 viral infection post transplant?

A

CMV

312
Q

What is the mechanism of azathioprine (Imuran)?

A

6MP derivative, purine analog that acts as an antimetabolite, decreases DNA synthesis

313
Q

What is the mechanism of cyclosporine?

A

Calcineurin inhibitor - inhibits mRNA encoding of IL-2

314
Q

What is the mechanism of mycophenolate (cellcept)?

A

blocks purine synthesis to decrease T and B cell proliferation

315
Q

What is the mechanism of tacrolimus (FK506)?

A

Calcineurin inhibitor - blocks IL-2 expressions/production from T cells - more potent than cyclosporine

316
Q

What is the mechanism of immunosuppression of prednisone?

A

blocks IL-1 from macrophages

317
Q

What is the mechanism of sirolimus (Rapamune)?

A

mTOR inhibitor - inhibits the response of IL-2 thereby blocking the activation of T and B cells

318
Q

What is the most common cause of biliary complications post liver transplant?

A

ischemia - check hepatic arterial flow

319
Q

What is the #1 cause of oliguria s/p renal transplant?

A

ATN

320
Q

What are the zones of the neck?

A

I - cricoid to sternum (thoracic inlet)

321
Q

What is a positive DPL?

A

gross blood, or identification of food particles, bacteria, bile, >100K RBC/mm, or 500 WBC/mm

322
Q

What are the indications for thoracotomy after chest tube placement?

A

>1500 cc blood out initially or >200 cc/hr x3 hours

323
Q

What is the cause of petechiae, hypoxia, and confusion/agitation after a femur fracture? How is the diagnosis made?

A

Fat emboli;

324
Q

What are traumatic diaphragm injuries usually located?

A

8:1 on the left

325
Q

What are the effects of splenectomy on the immune system?

A

decreased tuftsin, properidin, and fibronectin (non-specific opsonins), decreased IgM production - susceptible to encapsulated organisms

326
Q

What % of patients does splenectomy improve: hereditary spherocytosis? ITP?

A

100% spherocytosis

327
Q

What is the treatment for TTP?

A

plasmapheresis, not splenectomy

328
Q

What are the physiological effects of ARDS?

A

decreased pulmonary compliance

329
Q

How does aging affect PFTs?

A

reduces FEV1 and FRC

330
Q

What equation describes oxygen delivery?

A

CO x O2 content = CO x Hgb x 1.3 x SpO2

331
Q

What equation describes oxygen use?

A

CO x (CaO2 - CvO2)

332
Q

What are the effects of PEEP on the lungs?

A

Increased FRC, increased compliance

333
Q

What is functional residual capacity (FRC)?

A

air in lungs after normal exhalation

334
Q

What is inspiratory capacity?

A

maximum amount of air able to be inhaled (TV + inspiratory reserve volume IRV)

335
Q

What is vital capacity?

A

greatest volume that can be exhaled (IRV + TV + ERV)

336
Q

What causes an increase in oxygen dissociation from hemoglobin (‘right shift’)?

A

increased temperature, CO2, H+, 2,3DPG (high altitude, babies)

337
Q

What is the treatment of carbon monoxide poisoning?

A

100% O2 - reduces CO half-life from 5 hrs to 1 hr

338
Q

What are the characteristics of silvadene?

A

good activity against candida/pseudomonas, poor eschar penetration. risk of neutropenia

339
Q

What are the characteristics of mafenide acetate (sulfamylon)?

A

painful, can cause acidosis due to carbonic anhydrase inhibition

340
Q

What are the characteristics of silver nitrate?

A

Can cause hyponatremia and hypochloremia due to leeching of NaCl

341
Q

What is the #1 infection in burn patients?

A

pneumonia

342
Q

What is a Marjolin’s ulcer?

A

SCCA that develops in a chronic burn wound

343
Q

What is the effect of EDRF (endothelium derived relaxing factor)

A

vasodilation via cGMP, increased in sepsis; nitric oxide is most common example

344
Q

What are markers for non-seminomatous testicular cancer?

A

AFP and B-HCG

345
Q

What is the surgical approach to biopsy a testicular mass?

A

Orchiectomy via inguinal incision. Never trans-scrotal

346
Q

What stage seminomas get RT? Chemotherapy?

A

All stages - very radiosensitive

347
Q

What are the long term effects of cryptorchidism?

A

increased testicular cancer, orchiopexy can increase fertility but not decrease cancer risk

348
Q

What is the treatment of testicular torsion?

A

Bilateral orchiopexy

349
Q

How is a urethral injury diagnosed?

A

retrograde urethrogram (RUG), do not place foley - needs suprapubic catheter

350
Q

What is the treatment for a traumatic bladder injury?

A

Extraperitonal - a/w pelvic fx, foley only for drainage Intraperitoneal - no pelvic fx, usually dome rupture - laparotomy with multi-layer closure and foley

351
Q

What are the most common type of kidney stones?

A

oxalate - especially after small bowel resection

352
Q

What type of kidney stones are associated with proteus infection?

A

struvite stones, ‘staghorn’ - proteus produces urease

353
Q

What is the classic triad of renal cell carcinoma?

A

abd pain (capsule stretching), mass, hematuria

354
Q

Where is erythropoetin made? What stimulates its production?

A

95% made in kidney, stimulated by hypoxia, (decreased production in ESRD)

355
Q

What causes fever and hypertension in a renal cell carcinoma patient?

A

Increased erythropoetin - erythrocytosis

356
Q

What is the #1 peripheral aneurysm?

A

popliteal

357
Q

What are popliteal aneurysms associated with?

A

50% bilateral, 1/3 have AAA

358
Q

When do you treat a splenic aneurysm?

A

If >2 cm, child bearing age, planning pregnancy, or symptomatic then resect, otherwise can just monitor

359
Q

Bloody diarrhea POD#2 after AAA repair - what is the next step?

A

sigmoidoscopy to eval for ischemia (due to loss of IMA) - if necrosis then take to OR

360
Q

What is the initial treatment of claudication?

A

smoking cessation, excercise, trental - not surgery

361
Q

What is the #1 CN injury during CEA?

A

vagus nerve (clamp application) - hoarseness

362
Q

What are the long-term effects of PID?

A

Increased risk of infertility and ectopic pregnancy

363
Q

What is a Krukenberg tumor?

A

colon or stomach CA met to ovary - see signet cells on path

364
Q

What is Meig’s syndrome?

A

pelvic tumor -> ascites, hydrothorax

365
Q

Rectal bleeding, irregular menses, pelvic pain, and bluish mass on proctoscopy in a female - what is the diagnosis?

A

Endometriosis involving the rectum

366
Q

What is the treatment of endometriosis?

A

hormonal therapy

367
Q

What is the staging of ovarian cancer?

A

I - limited to ovary

368
Q

What is a Howship Romberg sign?

A

inner thigh pain with internal rotation - indicates obturator hernia

369
Q

What does the ileoinguinal nerve innervate?

A

sensation to inner thigh and scotum

370
Q

What does the genitofemoral nerve innervate?

A

travels along spermatic cord to innervate cremaster muscle and scrotal skin

371
Q

What is a spigelian hernia?

A

Hernia inferior to linea semicircularis through linea semilunaris - deep to ext oblique

372
Q

What is a Petit’s hernia?

A

Hernia through lumbar triangle (iliac crest, ext oblique, latissimus dorsi)

373
Q

Describe the innervation to the pectoralis muscles

A

Medial pectoral nerve to pec major and minor; lateral pectoral nerve to pec major only

374
Q

What biopsy finding in fibrocystic disease of the breast has an increased cancer risk?

A

Atypical ductal or lobular hyperplasia

375
Q

What is the FEV1 required for a: wedge resection? lobectomy? pneumonectomy?

A

0.6L; 1L; 2L

376
Q

What ABG values increase the risk of a lung resection?

A

pCO2 >45 or pO2 <50 at rest

377
Q

What marks the transition between the anal canal and the rectum?

A

Levator ani

378
Q

What is primary, secondary, and tertiary peristalsis?

A

Primary - CNS initiates swallow, occurs with food bolus; Secondary - occurs with esophageal distention (propagating waves); Tertiary - non-propagating/dysfunctional

379
Q

What is the most common site of esophageal perforation?

A

Cricopharyngeal muscle (usually by EGD)

380
Q

What is Mirizzi syndrome?

A

Compression and/or inflammation of common hepatic duct by a stone in the infundibulum of the gallbladder causing stricture and hepatic duct obstruction

381
Q

What is the normal half-life of: RBCs? PMNs? platelets?

A

RBC - 120 days; PMNs - 1-2 days; platelets - 7 days

382
Q

What is the mechanism and effect of Amrinone?

A

Phosphodiesterase inhibitor - inotrope, increases CO and decreases SVR

383
Q

What is a side effect of carbapenems?

A

Seizures

384
Q

What are side effects of aminoglycosides?

A

Reversible nephrotoxicity, irreversible ototoxicity

385
Q

What is the mechanism of rifampin?

A

RNA polymerase inhibitor

386
Q

Which antibiotic can affect platelets?

A

PCNs and cephalosporins - can bind platelets and increase bleeding times

387
Q

What triggers renin release?

A

Macula densa senses low Na/Cl

388
Q

What is the mechanism of malignant hyperthermia?

A

Ca release from sarcoplasmic reticulum

389
Q

What does antithrombin III do?

A

binds to and inhibits thrombin; inhibits factors IX, X, XI. Heparin binds this

390
Q

How do you calculate nitrogen balance?

A

N balance = N in - N out = Protein/6.25 - (24 hr urine N + 4g)

391
Q

What converts natural killer cells to lymphokine activated killer cells?

A

IL-2

392
Q

What is the mechanism of metronidazole?

A

produces oxygen radicals that breakup DNA

393
Q

What are the effects of ketamine?

A

increases cardiac work, O2 use, secretions, and BP; no respiratory distress; hallucinations possible

394
Q

What are side effects of vancomycin?

A

Redman syndrome (histamine release), nephrotoxicity, ototoxicity

395
Q

What are side effects of metronidazole?

A

Disulfiram-like reaction, peripheral neuropathy

396
Q

What are 3 laboratory indications of low volume, ‘pre-renal’

A

FeNa <1, Urine Na <20, BUN/Cr >30

397
Q

What is the function of peptide YY? Where is it secreted?

A

inhibits acid secretion, ‘ileal break’; released from terminal ileum

398
Q

How does prostate surgery affect clotting?

A

Can release urokinase -> activates plasminogen -> thrombolysis

399
Q

How do sequential compression devices work?

A

Improve venous return and release tPA -> induce fibronolysis

400
Q

What are the side effects of halothane?

A

renal and liver toxicity

401
Q

What fractures are associated with non-union?

A

clavicle, 5th metatarsal fracture

402
Q

Which organisms are carbapenems least effective against?

A

MEPP: MRSA, enterococcus, proteus, pseudomonas

403
Q

What are indications for radiation to an extremity sarcoma?

A

high grade, close margins, or tumor >5 cm

404
Q

What genes are associated with breast cancer?

A

p53, bcl-2, c-myc, c-myb, her2neu

405
Q

What is the mechanism of ulcer formation with chronic NSAID use?

A

Inhibits prostaglandin synthesis, causing decreased mucus and bicarb secretion and increased acid production

406
Q

What are the types of wounds and their respective wound infection rates?

A

Clean (hernia) - 2%; Clean-contaminated (prepped colon resection) - 3-5%; Contaminated (GSW to colon with repair) - 5-10%; Gross contamination (abscess) - 30%

407
Q

What are common causes of GIB in HIV?

A

Lower > Upper; Upper - Kaposi sarcoma, lymphoma; Lower - CMV, bacterial, HSV

408
Q

What is Comedo breast cancer? What is the treatment?

A

Most aggressive subtype of DCIS, has necrotic areas, high risk of microinvasion and recurrence; Rx - mastectomy

409
Q

What is Paget’s disease of the breast? Treatment?

A

Scaly skin lesion on nipple, suggesting underlying DCIS or ductal CA; Rx - MRM if cancer present, simple mastectomy if not

410
Q

What are the indications for chemotherapy in breast cancer?

A

>1 cm tumor or positive nodes (except postmenopausal women with positive estrogen receptors -> tamoxifen)

411
Q

Describe the relevant anatomy of the diaphragm

A

T8 - vena cava; T10 - esophagus + vagus; T12 - aorta + thoracic duct

412
Q

When do you resect a thymoma?

A

All require resection, 50% are malignant

413
Q

What do you suspect with a pansystolic murmur 2-7 days after an MI?

A

Post-MI VSD

414
Q

What is the anatomy of the thoracic duct?

A

Enters chest on right with aorta at T12, crosses to left at T4, then joins left subclavian at junction with IJV

415
Q

What are the types and treatment of aortic dissections?

A

Stanford: A = involves ascending, always needs surgery; B = does not involve ascending, medical management unless persistent pain or end-organ ischemia

416
Q

What is the most common congenital heart defect?

A

Ventricular septal defect

417
Q

Which hormones are involved in paraneoplastic syndromes of: squamous cell lung CA? small cell lung CA?

A

Squamous cell - PTH-related peptide; Small cell - ACTH (most common), ADH

418
Q

What is a catamenial pneumothorax?

A

PTX occurring in temporal relation to menstruation, caused by endometrial implants in visceral lung pleura

419
Q

What are the most common types of anal canal tumors?

A

Squamous cell (AKA epidermal, basaloid, cloacogenic, transitional), Adenocarcinoma, and melanoma

420
Q

What is the treatment for a low T2 rectal carcinoma?

A

APR or LAR (need 2cm margin from levator muscles for LAR)

421
Q

What is pyoderma gangrenosum? What is the treatment?

A

Painful raised pustules on skin with necrotic center which progress to spreading ulceration - a/w IBD; Rx - local wound care, steroids, dapsone

422
Q

Which extraintestinal manisfestations of UC do not improve after colectomy?

A

Primary sclerosing cholangitis and ankylosing spondylitis

423
Q

What does manometry showing normal LES tone but strong unorganized contractions suggest? What is the treatment?

A

Diffuse esophageal spasm; Rx - Ca channel blockers and nitrates

424
Q

What does manometry showing increased LES pressure, incomplete relaxation, and no peristalsis suggest? What is the treatment?

A

Achalasia; Rx - Ca channel blockers and LES dilation first (60% effective), if fail - Heller myotomy (LES circular muscle transection) + Nissen

425
Q

What is the most commonly injured nerve with parotid surgery?

A

Greater auricular nerve - numbness over lower portion of auricle

426
Q

How does clopidogrel (Plavix) affect platelets?

A

ADP receptor antagonist

427
Q

What is the most common cause of a spontaneous intestinal fistula?

A

crohn’s disease

428
Q

What is the most common site of GI lymphoma?

A

stomach

429
Q

Which segment of the liver drains directly into IVC?

A

Segment I - caudate lobe

430
Q

What is the initial treatment of GI bleeding in Mallory-Weiss syndrome?

A

Observation - most cases stop with nonoperative management

431
Q

For what condition is the risk of overwhelming postsplenectomy sepsis highest?

A

Thalassemia

432
Q

What is the most common cause of hypercalcemic crisis?

A

malignancy

433
Q

What does the sudden onset of glucose intolerance in a patient receiving TPN indicate?

A

sepsis

434
Q

What vitamin deficiency causes dermatitis, diarrhea and dementia?

A

Niacin - this syndrome is called Pellegra

435
Q

What can enhance immune function in critical illness?

A

arginine

436
Q

What is an effect of stored blood?

A

Decreased 2,3-DPG - leftward shift of oxygen disassociation curve

437
Q

What is the pathophysiology of ITP?

A

Antiplatelet IgG originating in the spleen

438
Q

What hematologic disease has the highest morbidity after splenectomy?

A

Myeloid dysplasia

439
Q

What vitamin deficiency causes dermatitis, hair loss, and thrombocytopenia?

A

Essential fatty acid deficiency

440
Q

What is the most common complication of heparin reversal with protamine?

A

Hypotension

441
Q

What is the optimal treatment for bleeding gastric varices in chronic pancreatitis?

A

Splenectomy

442
Q

What does a RQ >1 indicate? What does a RQ <0.7 indicate?

A

>1 = lipogenesis (overfeeding); <0.7 = ketosis and fat oxidation (starving)

443
Q

What is fetal wound healing characterized by?

A

increased hyaluronic acid synthesis

444
Q

What is the most common cause of hypercalcemia in breast cancer?

A

Parathyroid Hormone Related Peptide (PTHrP

445
Q

Which nerve injury results in foot drop? Which nerve injury results in decreased foot eversion?

A

Foot drop = deep peroneal nerve

446
Q

Treatment?

A

congenital torticollis Treatment = physical therapy, rarely surgical resection of muscle

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