Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Residency > Absite new 2 > Flashcards

Absite new 2 Flashcards

1
Q

Arterial supply and vascular drainage of adrenal gland

A
  • Superior adrenal – inferior phrenic artery
  • Middle adrenal – aorta
  • Inferior adrenal – renal artery
  • Left adrenal vein goes to left renal vein.
  • Right adrenal vein goes to inferior vena cava
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lymphatic drainage of adrenal medulla

A

Lymphatics drain to subdiaphragmatic and renal lymph nodes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

GFR zones of adrenal cortex

A

SALT, SUGAR and SEX STEROIDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cortisol effect

A

inotropic, chronotropic, and increases vascular resistance; proteolysis and gluconeogenesis; decreases inflammation, glycogenolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Aldosterone secretion is stimulated by

A
  1. angiotensin 2
  2. hyperkalemia
  3. to some extent ACTH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which CAH is salt wasting

A

21-hydroxylase deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which CAH has low testosterone

A

17-hydroxylase deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MC cause of primary hyperaldosteronism (Conn’s syndrome)

A

bilateral idiopathic adrenal hyperplasia

(Renin is low)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of secondary adrenal hyperplasia

A

CHF, Renal artery stenosis, Renin secreting tumor…etc

(Renin is high)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Patient with HTN and hypokalemia you think of

A

Hyperaldosteronism (Conn’s syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dx for primary hyperaldosteronism

A
  1. Salt-load suppression test (best, urine aldosterone will stay high)
  2. Aldosterone:renin ratio > 25
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MCC of hypocortisolism (Addison disease)

A

withdrawal of exogenous steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cosyntropin test

A

give ACTH and measure cortisol level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hypotension not responding to fluids or pressors think of

A

Acute adrenal insufficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MC cause of hypercortisolism (Cushing’s syndrome)

A

Exogenous steroid intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Best test to diagnose Cushing syndrome

A

24-hour urinary cortisol level (best), ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

High dose dexamethasone suppression test effect on ectopic producer of ACTH

A

does not suppress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cushing’s disease (not syndrome) refers to

A

pituitary adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MC non-iatrogenic cause of hypercortisolism

A

pituitary adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Rate limiting enzyme in catecholamines production

A

tyrosine hydroxylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Enzymes that convert norepinephrine into epinephrine is only found in

A

adrenal medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MC location of extraadrenal neural crest tissue

A

usually in the retroperitoneum, most notably in the organ of Zuckerkandl at the aortic bifurcation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

10% rule of pheochromocytoma

A

malignant, bilateral, in children, familial, extra-adrenal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Preoperative management in pheochromocytoma

A

good volume resuscitation

give alpha blocker before beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Most common extramedullary tissue site for pheochromocytoma

A

organ of Zuckerkandl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Superior and middle thyroid veins drain

A

internal jugular vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Inferior thyroid vein drain

A

innominate (brachiocephalic vein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

MC injured nerve following thyroidectomy

A

superior laryngeal nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Tubercles of Zuckerkandl of thyroid

A

most posterior-lateral extension of thyroid gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Thyroglobulin function

A

stores T3 and T4 in colloid within follicular cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Thyroxine binding protein function

A

transport protein that binds most of T3 and T4 in plasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Wolf-Chaikoff effect

A

patient given high doses of iodine

(Lugol’s solution, potassium iodide) inhibit T3 and T4 release (used in Thyroid Storm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Most thyroid nodules are benign (T or F)

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Best initial test for thyroid nodules

A

FNA and TFT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Nodules that warrant FNA (according to size)

A

nodules 5mm or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Colloid tissue on thyroid nodule FNA, what’s next

A

most likely colloid goiter; low chance of malignancy (< 1%)

  • Tx: thyroxine; lobectomy if it enlarges
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Normal thyroid tissue on FNA with elevated TFT most likely

A

solitary toxic nodule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

MCC of goiter worldwide

A

iodine deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Most important aspect before removal of a lingual thyroid

A

Is the only thyroid tissue in 70% of patients who have it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What hyperthyroid medication is safe in pregnancy

A

PTU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Methimazole and PTU MOA

A

Inhibits peroxidases and prevents iodine–tyrosine coupling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Causes of hyperthyroidism

A
  1. Graves disease (MC)
  2. Toxic multinodular goiter
  3. single toxic nodule
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Symptoms that are specific to Graves disease

A

exophthalmos
peritibial edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Graves disease pathogenesis

A

IgG antibodies (LATS, TSI) to TSH receptor / Type 2 Hypersensitivity reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

MC indication for thyroidectomy in Graves disease

A

suspicious nodule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Preop preparation thyroidectomy in Graves disease

A

methimazole until euthyroid, β-blocker, Lugol’s solution for 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Preferred initial treatment for toxic multinodular goiter

A

surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Causes of Thyroiditis

A
  1. Hashimoto’s thyroiditis
  2. De Quervain’s thyroiditis (subacute granulomatous thyroiditis)
  3. Bacterial Thyroiditis
  4. Riedel’s fibrous struma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Pathogenesis of Hashimoto’s

A

both cellular and humoral immune mediated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Cause of goiter in Hashimoto’s

A

lack of organification of trapped iodide inside gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Reidel’s fibrous struma thyroiditis

A

Woody, fibrous component that can involve adjacent strap muscles and carotid sheath

Disease commonly cause hypothyroidism and compressive symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Types of thyroid cancer

A
  1. papillary
  2. follicular
  3. medullary
  4. hurthle cell thyroid cancer
  5. anaplastic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Features worrisome for thyroid malignancy

A

solid solitary cold nodule
Men
age >50
previous XRT
MEN2a MEN2b
voice change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

MC type of thyroid cancer

A

papillary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Route of spread of papillary thyroid CA

A

lymphatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Prognosis of papillary thyroid CA based on

A

local invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Histopathology of papillary CA

A

psammoma bodies
orphan Annie nuclei

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Risk Factors for thyroid CA recurrence/metastasis

A

X-GAMES
– previous XRT, high grade, age (< 20 or > 50), males, extrathyroidal disease, and size (> 1 cm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Worse prognosis of medullary thyroid CA

A

sporadic type
MEN2b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Medullary thyroid CA tumor arises from which cells

A

parafollicular C cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

1st manifestation of MEN IIa and IIb

A

Diarrhea (due to calcitonin release from medullary thyroid CA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Age for prophylactic thyroidectomy and central node dissection is determined by specific RET proto-oncogene codon mutation risk

A
  • Level A codon – before age 10 or earlier if lacks low-risk criteria
  • Level B codon – before age 5 or later if low-risk criteria
  • Level C codon – before age 5
  • Level D codon – first year of life

(Low-risk criteria: normal calcitonin level, normal neck U/S, less aggressive MTC family history)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Iodine ablation therapy is only effective for which types of thyroid CA

A

papillary
follicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How to monitor for recurrence after surgery for papillary, follicular and medullary thyroid CA

A

papillary and follicular thyroglobulin level

Medullary: calcitonin level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Most important factor before initiating iodine ablation therapy

A

Make sure TSH is high to facilitate uptake of radioactive iodine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Superior parathyroid are formed embryologically

A

4th pharyngeal pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Inferior parathyroid are formed embryologically

A

3rd pharyngeal pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Anatomy of superior parathyroid gland

A

found lateral to the RLN and superior to the inferior thyroid artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Anatomy of the inferior parathyroid gland

A

below inferior thyroid artery
medial to the RLN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

MC location of ectopic parathyroid gland

A

tail of thymus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Osteitis fibrosa cystica

A

(brown tumors) – bone lesions from Ca resorption; characteristic of hyperparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Labs in primary hyperparathyroidism

A

↑ PTH and ↑ Ca; ↓ PO4−; Cl− to PO4− ratio > 33; ↑ renal cAMP;
high urinary Ca (24-hour urine collection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Secondary hyperparathyroidism is seen in

A

renal failure patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Synchronous tumors

A

Cases in which the second primary cancer is diagnosed within 6 months of the primary cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Metachronous tumors

A

Cases in which a second primary tumor is diagnosed (develops) more than 6 months after the primary cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Sestamibi scan

A

Best for trying to pick up missing / ectopic parathyroid glands and for reops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Familial hypercalcemic hypocalciuria pathogenesis

A

Caused by defect in PTH receptor in distal convoluted tubule of the kidney that causes ↑ resorption of Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Pseudohypoparathyroid pathogenesis

A

defect in PTH receptor in the kidney, does not respond to PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Diarrhea is often the presenting symptom in what MEN syndromes

A

MEN2a
MEN2b

(due to increased calcitonin from medullary thyroid CA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

MEN1 (MENIN gene)

A

(3Ps)
pituitary adenoma
parathyroid hyperplasia
pancreatic neuroendocrine tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

MEN2a (RET proto-onco gene)

A

(2Ps,1M)
Parathyroid hyperplasia
Medullary thyroid CA
pheochromocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

MEN2b (RET proto-onco gene)

A

(1P,2Ms)
pheochromocytoma
Medullary thyroid CA
mucosal neuromas
marfinoid habitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

PTHrP secreted by which CA

A

squamous cell lung CA
Breast CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Long thoracic nerve innervates

A

innervates serratus anterior; injury results in winged scapula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Lateral thoracic artery supply

A

supplies serratus anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Thoracodorsal nerve innervated

A

innervates latissimus dorsi; injury results in weak arm pull-ups and adduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Thoracodorsal artery supply

A

supplies latissimus dorsi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Medial pectoral nerve innervate

A

innervates pectoralis major and pectoralis minor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Lateral pectoral nerve innervates

A

pectoralis major only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Intercostobrachial nerve

A

lateral cutaneous branch of the 2nd intercostal nerve; provides sensation to medial arm and axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Breast arterial supply

A

Branches of internal thoracic (mammary) artery, intercostal arteries, thoracoacromial artery, and lateral thoracic artery supply breast.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Mondor’s disease

A

superficial vein thrombophlebitis of breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Green/yellow/brown nipple discharge consistent with

A

fibrocystic disease of the breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Fibrocystic disease of the breast types

A

sclerosing adenosis, apocrine metaplasia, duct adenosis, epithelial hyperplasia, ductal hyperplasia, and lobular hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

DCIS subtypes and the most aggressive of them all

A

comedo, papillary, cribriform, solid

comedo most aggressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Screening for breast cancer has decreased mortality by

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Screening for breast CA age

A
  • Average risk – annual mammogram starting at age 40
  • High-risk – annual mammogram and MRI starting age 25-40
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

BRCA screening

A
  • Yearly mammogram and breast MRI starting at age 25
  • Yearly pelvic exam + U/S and CA-125 starting at age 25
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Lung CA screening

A

yearly low dose CT chest

Indicated for patients 50–80 years old with > 20 pack-year smoking history and are currently smoking or who have quit within last 15 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

MC solitary pulmonary nodule

A

Granuloma, hamartoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Persistent air leaks occurs after which type of thoracic surgeries

A

wedge segmentectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Lung cancer prognosis based on

A

nodal involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Types of lung cancer

A

Non–small cell carcinoma:
1. squamous cell ca
2. adenocarcinoma

Small cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Small cell CA paraneoplastic syndrome

A

ACTH and ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

MC paraneoplastic syndrome ever

A

ACTH secreting small lung CA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Unresectable lung disease according to stage

A

N2, N3 or M disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

How does lung hamartomas appear on CT

A

calcification appear as popcorn lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Anterior mediastinal tumors

A

Ts
Thymoma
Thyroid CA or goiter
T-cell lymphoma
Teratoma
paraThyroid adenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Posterior mediastinal tumors

A

Enteric cysts
neurogenic tumors
lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Phases of empyema development

A

Exudative phase (1st week)
Fibro-proliferative phase (2nd week)
Organized phase (3rd–4th week)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Massive hemoptysis

A

> 600cc/24hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Spontaneous pneumothorax occurs more at which side

A

Right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Surgery for pneumothorax

A

VATS apical blebectomy and mechanical pleurodesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Catamenial pneumothorax

A

occurs in temporal relation to menstruation

  • Caused by endometrial implants in the visceral lung pleura
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Ductus arteriosus

A

connection between descending aorta and left pulmonary artery (PA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Ductus venosum

A

connection between portal vein and IVC; blood shunted away from liver in utero

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

MC ASD type

A

ostium secundum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

TOF components

A
  1. VSD
  2. Pulmonary stenosis
  3. RV hypertrophy
  4. Overriding aorta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Medication used to close a PDA

A

indomethacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Left main coronary branches

A

Left anterior descending
circumflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Organisms responsible for endocarditis

A

staph aureus (50% of cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Stages of atherosclerosis

A

1st foam cells
2nd smooth muscle proliferation
3rd intimal disruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Carotid sheath contains

A

carotid artery, internal jugular vein, vagus nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

MC site of carotid artery stenosis

A

bifurcation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

First branch of internal carotid artery

A

ophthalmic artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Gastrin produced by

A

G cells in stomach antrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Secretion of gastrin is stimulated by

A

amino acids, vagal input (acetylcholine), calcium, ETOH, antral distention, pH > 3.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Secretion of gastrin is inhibited by

A

pH < 3.0, somatostatin, secretin, CCK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Target cells for gastrin

A

parietal cells and chief cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Effect of gastrin

A

↑ HCl, intrinsic factor, and pepsinogen secretion (gastrin is the strongest stimulator for all)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Somatostatin produced by

A

mainly produced by D (somatostatin) cells in stomach antrum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Secretion of somatostatin is stimulated by

A

acid in the duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Target cells of somatostatin

A

Many cells !!
it is the great INHIBITOR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Effect of somatostatin

A
135
Q

Target cells for gastrin

A

Parietal cells and chief cells

136
Q

Somatostatin produced by

A

Mainly produced by D (somatostatin) cells in stomach antrum

137
Q

Secretion of somatostatin is stimulated by

A

Acid in the duodenum

138
Q

Target cells of somatostatin

A

Many cells !! It is the great INHIBITOR

139
Q

Effect of somatostatin

A

Inhibits gastrin and HCl release (primary role); inhibits release of insulin, glucagon, secretin, CCK, and motilin; ↓ pancreatic and biliary output; slows gastric emptying

140
Q

Octreotide MOA

A

Somatostatin analogue

141
Q

CCK produced by

A

Produced by I cells of duodenum

142
Q

Secretion of CCK stimulated by

A

Amino acids and fatty acid chains

143
Q

Effect of CCK

A

Gallbladder contraction, relaxation of sphincter of Oddi, ↑ pancreatic enzyme (exocrine) secretion (acinar cells)

144
Q

Secretin is produced by

A

S cells of duodenum

145
Q

Secretion of secretin is stimulated by

A

Fat, bile, pH < 4.0

146
Q

Secretion of secretin is inhibited by

A

pH > 4.0, gastrin

147
Q

Effect of secretin

A

↑ pancreatic HCO3− release (ductal cells), inhibits gastrin release (this is reversed in patients with gastrinoma), and inhibits HCl release

148
Q

Vasoactive intestinal peptide produced by

A

Pancreas and gut

149
Q

Secretion of VIP is stimulated by

A

Fat, acetylcholine

150
Q

Effect of VIP hormone

A

Increase water and electrolyte intestinal secretion; increase gut motility

151
Q

Glucagon is secreted by

A

Alpha cells of the pancreas

152
Q

Glucagon release is stimulated by (starvation state)

A

↓ glucose, ↑ amino acids, acetylcholine

153
Q

Glucagon release is inhibited by

A

↑ glucose, ↑ insulin, somatostatin

154
Q

Effect of glucagon

A

Glycogenolysis, gluconeogenesis, ↓ gastric acid secretion, ↓ gastrointestinal motility, relaxes sphincter of Oddi, ↓ pancreatic secretion

155
Q

Insulin is secreted by

A

Beta cells of the pancreas

156
Q

Secretion of insulin is stimulated by (fed state)

A

Glucose, glucagons, CCK

157
Q

Secretion of insulin is inhibited by

A

Somatostatin

158
Q

Motilin is produced by

A

Mo cells in the upper small bowel

159
Q

Bowel recovery in order

A
  • Small bowel 24 hours
  • Stomach 48 hours
  • Large bowel 3–5 days
160
Q

Peristalsis phases of bowel

A
  • I – resting
  • II – accelerating
  • III – peristalsis
  • IV – decelerating
161
Q

Esophageal lining is made up of

A

Non-keratinized squamous cell epithelium

162
Q

Muscle types of the esophagus

A

● Upper ⅓ esophagus – striated muscle
● Middle ⅓ and lower ⅓ esophagus – smooth muscle

163
Q

Arterial supply of the esophagus

A

● Thoracic esophagus – vessels directly off the aorta are the major blood supply
● Cervical esophagus – supplied by inferior thyroid artery
● Abdominal esophagus – supplied by left gastric and inferior phrenic arteries

164
Q

Venous drainage of the esophagus

A

Hemi-azygous and azygous veins in the chest

165
Q

Left vagus travels

A

Anteriorly

166
Q

Right vagus travels

A

Posteriorly

167
Q

Length of esophagus

A

Around 25 cm

168
Q

Length between the incisors and lower esophageal sphincter

A

Around 40 cm

169
Q

Anatomic areas of esophageal narrowing

A
  • Cricopharyngeus muscle
  • Compression by the left mainstem bronchus and aortic arch
  • Diaphragm (near lower esophageal sphincter)
170
Q

In pharyngeoesophageal disorders patients have more trouble with liquid or solid foods

A

Liquid

171
Q

Plummer-Vinson syndrome

A

Esophageal web, iron deficiency anemia

172
Q

Zenker’s diverticulum is what type of diverticulum

A

False diverticulum

173
Q

Where is Zenker’s diverticulum located

A

Located posteriorly; occurs between superior pharyngeal constrictors and inferior cricopharyngeus (Killian’s triangle)

174
Q

Causes of Zenker’s diverticulum

A

Failure of UES to relax leading to an increase in pressure

175
Q

Traction esophageal diverticulum is true or false

A

True

176
Q

Epiphrenic diverticulum is true or false

A

False

177
Q

Pathogenesis of achalasia

A

Secondary to destruction of inhibitory neuronal ganglion cells in muscle wall (autoimmune, infectious, genetic)

178
Q

Difference between diffuse esophageal spasm and nutcracker esophagus

A

Manometry for DES high amplitude NON-peristaltic movements; for nutcracker high amplitude peristaltic movements

179
Q

Scleroderma of the esophagus pathogenesis

A

● Fibrous replacement of esophageal smooth muscle
● Causes dysphagia and loss of LES tone with massive reflux and strictures

180
Q

Best test to diagnose GERD

A

24 hour pH probe

181
Q

Most common cause of dysphagia following Nissen

A

Wrap is too tight (generally resolves on its own; give clears for 1st week; can dilate after 1 week)

182
Q

Types of hiatal hernia

A

● Type I – sliding hernia from dilation of hiatus (most common type)
● Type II – paraesophageal
● Type III – combined
● Type IV – sliding with entire stomach in the chest plus another organ

183
Q

Needs Barrett’s surveillance for lifetime even after Tx why?

A

Barrett’s CA risk is not reversed with PPI or fundoplication.

184
Q

Risk factors for esophageal adenocarcinoma

A

GERD, obesity, Barrett’s

185
Q

MC esophageal CA

A

Adenocarcinoma

186
Q

Degrees of esophageal caustic injuries

A
  • Primary burn – hyperemia
  • Secondary burn – ulcerations, exudates, and sloughing
  • Tertiary burn
187
Q

Epidermis is subdivided into 5 layers

A

The stratum basale (deepest), the stratum spinosum, the stratum granulosum, the stratum lucidum and the stratum corneum (superficial)

188
Q

TIVA (total intravenous anaesthesia) advantage

A

Reduce postoperative nausea and vomiting

189
Q

Ligasure can seal vessels up to

A

7mm in diameter

190
Q

Harmonic scalpel vs ligasure

A

Harmonic scalpel uses ultrasound vibration; ligasure uses thermal energy

191
Q

MC hepatic artery variant

A

Right hepatic artery comes off SMA

192
Q

Line that divides liver into right and left lobe

A

Cantlie’s line

193
Q

Line that divides left lobe of the liver into medial and lateral

A

Falciform ligament

194
Q

Portal triad and gallbladder are found in which liver segments

A

IV, V

195
Q

Kupffer cells

A

Liver macrophages

196
Q

Foramen of Winslow borders

A
  • Anterior – portal triad
  • Posterior – IVC
  • Inferior – duodenum
  • Superior – liver (caudate lobe)
197
Q

Most primary and secondary liver tumors are supplied by

A

Hepatic artery

198
Q

Usual energy source for liver

A

Ketones

199
Q

The only water-soluble vitamin stored in the liver

A

B12

200
Q

Primary bile acids (cholic and chenodeoxycholic) are made by

A

Bile salts are conjugated to taurine or glycine

201
Q

Deficiency in storage ability; high conjugated bilirubin

A

Rotor’s syndrome

202
Q

Deficiency in secretion ability; high conjugated bilirubin

A

Dubin–Johnson syndrome

203
Q

Urgent liver TXP listing if

A

King’s College criteria are met.

204
Q

Budd–Chiari syndrome

A

Hepatic vein occlusive disease (a cause of postsinusoidal portal HTN)

205
Q

Child-Pugh Score depends on what parameters

A

Albumin, Bilirubin, INR, Encephalopathy, Ascites

206
Q

MELD score depends on what parameter

A

Uses INR, creatinine, and total bilirubin

207
Q

Splenic vein thrombosis can lead to what type of varices

A

Gastric varices

208
Q

MC organism causing pyogenic abscess

A

E. coli

209
Q

Preop ERCP done in liver hydatid cyst to

A

Check for communication with the biliary system

210
Q

Most common benign hepatic tumor

A

Hemangioma

211
Q

Sulfur colloid scan for hepatic mass

A

No uptake for adenoma because no kupffer cells; positive uptake for Focal nodular hyperplasia because there are kupffer cells

212
Q

Metastasis: primary ratio of malignant liver tumors

A

20:1

213
Q

MC malignant liver cancer

A

HCC

214
Q

MC risk factor for HCC

A

Hep B

215
Q

Tumor marker for HCC

A

AFP

216
Q

Calot triangle border

A

Superior liver, medial common hep duct, lateral cystic duct

217
Q

Cystic artery is a branch off

A

Right hepatic artery

218
Q

Gallbladder has no

A

Submucosa

219
Q

Histopathology with cholecystitis

A

Rokitansky–Aschoff sinuses

220
Q

Bile leak after cholecystectomy you think off

A

Cystic duct stump, CBD injury, ducts of Luschka GB fossa

221
Q

Types of GB stones

A

Cholesterol stones, black stones, brown stones

222
Q

Risk factors for black GB stone

A

Hemolytic disorders, cirrhosis, chronic TPN

223
Q

MC location and cause for brown biliary stones

A

CBD; caused by infection in biliary tree

224
Q

Most sensitive test for cholecystitis

A

Cholecystokinin cholescintigraphy

225
Q

ACALCULOUS CHOLECYSTITIS risk factors

A

Severe burns, prolonged TPN, trauma, or major surgery

226
Q

PRIMARY SCLEROSING CHOLANGITIS is associated with

A

Ulcerative colitis

227
Q

Adenomyomatosis

A

Thickened nodule of mucosa and muscle associated with Rokitansky–Aschoff sinus

228
Q

Pancreatic blood supply

A
  • Head – superior (off GDA) and inferior (off SMA) pancreaticoduodenal arteries (anterior and posterior branches for each)
  • Body – great, inferior, and dorsal pancreatic arteries (all off splenic artery)
  • Tail – splenic, gastroepiploic, and caudal pancreatic arteries
229
Q

Only pancreatic enzymes secreted in its active form

A

Amylase

230
Q

Pathway of activation of pancreatic enzymes

A

Trypsinogen is activated to trypsin by enterokinase secreted by the duodenum; then trypsin activates EVERYTHING

231
Q

Major pancreatic duct that merges with CBD before entering duodenum

A

Duct of Wirsung

232
Q

Small accessory pancreatic duct that drains directly into duodenum

A

Duct of Santorini (s for small duct)

233
Q

Failed fusion of the pancreatic ducts is called

A

PANCREAS DIVISUM

234
Q

MCC death in pancreatitis

A

Sepsis

235
Q

Ranson’s criteria

A
  • On admission → age > 55, WBC > 16, glucose > 200, AST > 250, LDH > 350
  • After 48 hours: Hct ↓ 10%, BUN ↑ of 5, Ca < 8, PaO2 < 60, base deficit > 4, fluid sequestration > 6 L
236
Q

Best antibiotic to be given when needed for pancreatitis

A

Imipenem

237
Q

ARDS in pancreatitis is related to the release

A

Phospholipases

238
Q

Coagulopathy in pancreatitis is related to the release of

A

Proteases

239
Q

Mnemonic for ON admission Ranson criteria

A

WAGAL
wbc>16
age>55
glucose>200
AST>250
LDH>350

240
Q

PANCREATIC PSEUDOCYSTS not associated with pancreatitis or known trauma you need to r/o

A

Pancreatic CA

241
Q

MC cause of chronic pancreatitis

A

Alcohol

242
Q

Number 1 risk factor for pancreatic adenocarcinoma

A

Smoking

243
Q

Pancreatic neuroendocrine tumors are divided into

A

Non-functional (MC), functional

244
Q

MC functional PNET

A

Insulinoma

245
Q

Symptoms of insulinoma

A

Whipple’s triad – fasting hypoglycemia (< 55), symptoms of hypoglycemia, and relief with glucose

246
Q

C-peptide in insulinoma is

A

Increased

247
Q

MC PNET in MEN-1

A

Gastrinoma

248
Q

MC location of gastrinoma

A

Gastrinoma triangle

249
Q

Gastrinoma triangle

A

Common bile duct, neck of pancreas, third portion of the duodenum

250
Q

Symptoms of glucagonoma

A

Symptoms (4 D’s): Diabetes, Dermatitis (rash – necrolytic migratory erythema), Depression, DVT

251
Q

Symptoms of VIPoma

A

Watery diarrhea, hypokalemia, and achlorhydria (WDHA)

252
Q

Congenital lack of ligaments holding spleen in place is called

A

Wandering spleen

253
Q

ITP pathogenesis

A

Anti-platelet antibodies (IgG to GpIIb/IIIa and Gp Ia/IIa) – bind platelets; results in decreased platelets

254
Q

THROMBOTIC THROMBOCYTOPENIC PURPURA (TTP) pathogenesis

A

Due to ADAMTS13 defect (metalloproteinase that normally cleaves vWF); platelets go crazy and aggregates

255
Q

Vaccines needed before splenectomy

A

Pneumococcus, Meningococcus, H. influenzae

256
Q

When to give vaccine in splenectomy

A

Give vaccines at least 14 days before elective surgery or 14 days after emergency surgery

257
Q

Most common congenital hemolytic anemia requiring splenectomy

A

Spherocytosis

258
Q

Spherocytosis pathogenesis

A

Spectrin deficit (membrane protein, autosomal dominant) leads to less deformable RBCs and splenic culling/sequestration (hypersplenism).

259
Q

Which portions of the duodenum are retroperitoneal

A

2nd and 3rd

260
Q

B12 and folate absorption occur in

A

Terminal ileum

261
Q

Iron absorption occurs in

A

Duodenum

262
Q

Both jejunum and ileum are supplied by

A

SMA

263
Q

Arcades and vasa recta difference between ileum and jejunum

A

For jejunum larger fewer arcades with longer vasa recta

264
Q

Jejunum and ileum arterial supply

A

SMA

265
Q

Non conjugated bile acids are absorbed by

A

Passive diffusion

266
Q

How much bowel you need to survive off TPN

A

Probably need at least 75 cm to survive off TPN; 50 cm with competent ileocecal valve

267
Q

MCC of large bowel obstruction whether there history of surgery or no

A

Colon CA

268
Q

Failure of closure of the omphalomesenteric duct

A

MECKEL’S DIVERTICULUM

269
Q

Most common tissue found in Meckel’s

A

Pancreatic tissue

270
Q

When do you remove an incidentally found Meckel’s diverticulum

A

Gastric mucosa suspected (diverticulum feels thick) or has a very narrow neck

271
Q

Which IBD is more associated with bloody diarrhea

A

UC

272
Q

Age of presentation for Crohn’s disease

A

Bimodal distribution 20–30s, 50–60s

273
Q

Extraintestinal manifestations of Crohn’s disease

A
  1. Arthritis
  2. Uveitis
  3. Pyoderma gangrenosum
  4. Megaloblastic anemia
274
Q

MC involved bowel segment in Crohn’s

A

Terminal ileum

275
Q

Histopathology for Crohn’s disease

A

Transmural inflammation, noncaseating granuloma, cobblestoning, creeping fat, skip lesions, narrow deep ulcers

276
Q

Why do Crohn’s disease patients get calcium oxalate kidney stones

A

↓ oxalate binding to calcium secondary to ↑ intraluminal fat (fat binds Ca) → oxalate then gets absorbed in colon → released in urine → hyperoxaluria

277
Q

Best for localizing carcinoid tumor not seen on CT scan

A

Octreotide scan

278
Q

Most sensitive tumor marker for carcinoid tumor

A

Chromogranin A

279
Q

Peutz–Jeghers syndrome gene mutation

A

STK11 gene mutation; autosomal dominant

280
Q

Most common stomal infection

A

Candida

281
Q

Parastomal hernias is MC associated with

A

Colostomies

282
Q

Most common cause of stenosis of stoma

A

Ischemia

283
Q

FAP + osteomas called

A

Gardner’s syndrome

284
Q

FAP + brain tumors

A

Turcot’s syndrome

285
Q

Peutz–Jeghers syndrome

A
  • Benign hamartomas
  • Mucocutaneous pigmentation
286
Q

What is the most sensitive tumor marker for carcinoid tumor?

A

Chromogranin A

287
Q

What gene mutation is associated with Peutz–Jeghers syndrome?

A

STK11 gene mutation; autosomal dominant

288
Q

What is the most common stomal infection?

A

Candida

289
Q

Parastomal hernias are most commonly associated with which type of stoma?

A

Colostomies

290
Q

What is the most common cause of stenosis of stoma?

A

Ischemia

291
Q

FAP with osteomas is called what syndrome?

A

Gardner’s syndrome

292
Q

FAP with brain tumors is referred to as which syndrome?

A

Turcot’s syndrome

293
Q

What are the characteristics of Peutz–Jeghers syndrome?

A
  • Benign hamartomas
  • Mucocutaneous pigmentation
  • Increase risk of breast cancer
294
Q

GIST tumors arise from which cells?

A

Intestinal cells of Cajal

295
Q

What mutation in GIST tumors allows Gleevec (imatinib) to work?

A

Ckit mutation

296
Q

What is the most common location for GIST tumors?

A

Gastric

297
Q

What are the borders of the anal canal?

A

Extends from anorectal ring (puborectalis) to anal verge (squamous mucosa and perianal skin junction)

298
Q

What is the border of the anal margin?

A

From squamous mucocutaneous junction to 5 cm out radially

299
Q

What supplies the ascending and two-thirds of the transverse colon?

A

Supplied by SMA (ileocolic, right and middle colic arteries)

300
Q

What supplies the remaining one-third of the transverse colon, descending colon, sigmoid colon, and upper rectum?

A

IMA (left colic, sigmoid branches, superior rectal artery)

301
Q

What is the marginal artery?

A

Runs along colon margin, connecting SMA to IMA (provides collateral flow)

302
Q

What is the Arc of Riolan?

A

Short direct collateral connection between SMA and IMA

303
Q

What percentage of GI blood flow supplies the mucosa and submucosa?

A

80%

304
Q

The middle rectal artery is a branch of which artery?

A

Internal iliac artery

305
Q

The inferior rectal artery is a branch of which artery?

A

Internal pudendal artery (which is a branch of the internal iliac artery)

306
Q

Where does the superior rectal vein drain into?

A

IMV and eventually the portal vein

307
Q

Where do the middle and inferior rectal veins drain into?

A

Internal iliac veins and eventually the IVC

308
Q

What are the watershed areas of the large bowel?

A
  • Splenic flexure (Griffith’s point) – SMA and IMA junction
  • Rectum (Sudeck’s point) – superior rectal and middle rectal junction
309
Q

What nerve innervates the external sphincter muscle?

A

Internal pudendal nerve

310
Q

What is the pathogenesis of stump pouchitis?

A

Lack of short chain fatty acids

311
Q

What is Denonvilliers’ fascia in men?

A

Rectovesicular and rectoprostatic fascia

312
Q

What is Denonvilliers’ fascia in women?

A

Rectovaginal fascia

313
Q

What is Waldeyer’s fascia?

A

Rectosacral fascia

314
Q

What is the most common colon polyp?

A

Hyperplastic

315
Q

What are the risk factors for potentially cancerous polyps?

A

> 2 cm, sessile, or villous

316
Q

What is the most important prognostic factor for colon cancer?

A

Nodal status

317
Q

What gene mutation is associated with Familial Adenomatous Polyposis (FAP)?

A

APC; autosomal dominant

318
Q

What gene mutation is associated with Lynch syndrome?

A

DNA mismatch repair gene; also called hereditary nonpolyposis colon cancer; autosomal dominant

319
Q

What are the Amsterdam criteria for Lynch syndrome?

A

“3, 2, 1” → at least 3 first-degree relatives, over 2 generations, 1 with cancer before age 50

320
Q

What is the histopathology of Ulcerative colitis?

A

Chronic inflammation involving the mucosa and submucosa; CRYPT ABSCESS

321
Q

What are the complications of Ulcerative colitis?

A

Toxic colitis; toxic megacolon

322
Q

What are the criteria for toxic colitis?

A

> 6 bloody diarrhea/day; tachycardia; fever; leukocytosis

323
Q

What are the criteria for toxic megacolon?

A

Toxic colitis criteria + > 6 cm large bowel; abdominal distention, pain and tenderness

324
Q

Where is large bowel perforation with obstruction most likely to occur?

A

Cecum

325
Q

What is the rule of 3 for spermatic cord structures?

A

Rule of 3s for the spermatic cord:
- 3 layers: External spermatic fascia, cremasteric fascia and internal spermatic fascia.
- 3 arteries: Artery to vas deferens, testicular artery and cremasteric artery.
- 3 nerves: Genital branch of genitofemoral nerve, ilioinguinal nerve and sympathetics.
- 3 other structures: Pampiniform plexus, vas deferens and testicular lymphatics.

326
Q

What are the structures of the spermatic cord?

A

Testicular artery, pampiniform plexus, cremasteric muscle, vas deferens, ilioinguinal nerve, genital branch of the genitofemoral nerve

327
Q

What is a pantaloon hernia?

A

Direct and indirect components

328
Q

What is the most common early complication following hernia repair?

A

Urinary retention

329
Q

What is the most common cause of hernia recurrence?

A

Wound infection

330
Q

What is the recurrence rate of hernia?

A

2%

331
Q

What is the most commonly injured nerve with open inguinal hernia repair?

A

Ilioinguinal nerve

332
Q

What is the most commonly injured nerve with laparoscopic hernia repair?

A

Lateral femoral cutaneous nerve

333
Q

What are the boundaries of the femoral canal?

A

Cooper’s ligament (pectineal, posterior), inguinal ligament (anterior), femoral vein (lateral), and lacunar ligament (medial)

334
Q

What does loss of the cremasteric reflex and numbness on the ipsilateral penis, scrotum, and thigh after hernia surgery indicate?

A

Ilioinguinal nerve injury

Residency (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions