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Residency > absite part 2 bored > Flashcards

absite part 2 bored Flashcards

1
Q

clinical significance of criminal nerve of grassi

A

can cause persistently high acid levels if left undivided after vagotomy

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2
Q

Normal UES resting pressure vs normal LES resting pressing

A

UES: 60
LES: 15

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3
Q

Cancer associated with plummer vinson syndrome?

A

Oral cancer

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4
Q

pathophysiology of zenker’s diverticulum?

A

increase in pressure due to failure of cricopharyngeus muscle to relax

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5
Q

gold standard for diagnosis of zenker’s diverticulum?

A

Barium swallow

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6
Q

Traction diverticulum of the esophagus

A

True diverticulum
most commonly located in the mid lateral esophagus

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7
Q

epiphrenic diverticulum

A

A false diverticulum most commonly located in the distal 10cm of the esophagus
Mainly associated with motility disorders

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8
Q

pathophysiology of achalasia

A

destruction of inhibitory neural ganglion cells in muscle wall

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9
Q

manometric findings of achalasia

A

*high/normal pressure LES
*poor/no peristalsis

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10
Q

pathophysiology of scleroderma

A

fibrous displacement of esophageal smooth muscles

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11
Q

histopathology seen in barrets esophagus

A

goblet cells

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12
Q

Ca risk is increased by how much in barrets esophagus

A

50 times adenocarcinoma

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13
Q

Most common esophageal cancer worldwide

A

squamous Ca

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14
Q

what T stage of esophageal cancer is still resectable

A

T4a

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15
Q

invasion of pericardium, pleura and diaphragm is considered what T stage

A

T4a

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16
Q

Most common site of tumor and most common site of distant metastasis for esophageal adeno vs squamous Ca

A
  • Adenocarcinoma – usually in lower ⅓ of esophagus; liver metastases most common
  • Squamous cell carcinoma – usually in upper ⅔ of esophagus; lung metastases MC
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17
Q

Fanconi anemia increases the risk for what type of cancer

A

squamous cell CA of oral cavity and esophagus

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18
Q

what is TYLOSIS

A

autosomal dominant disease
● Hyperkeratosis of the palms and soles of feet
● 70% lifetime risk of squamous cell esophageal CA
● Upper endoscopy screening starting at age 20

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19
Q

Most common site of non-iatrogenic (mc boerhaave) esophageal perforation

A

left posterior lateral intrathoracic esophagus 2–4 cm above EGJ

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20
Q

Most common iatrogenic site for esophageal perforation

A

cervical esophagus near cricopharyngeus muscle

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21
Q

Meissner’s and Auerbach’s
plexuses location in the esophagus

A

Meissner’s and Auerbach’s
plexuses, are found in the submucosa and between the muscle
layers of the esophagus, respectively.

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22
Q

swallowing center is located in the

A

Medulla

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23
Q

The most
common operative finding on repeated fundoplication

A

herniated wrap

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24
Q

source of bleeding in Mallory-Weiss tears

A

arterial bleeding

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25
Q

most common problem following vagotomy

A

diarrhea

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26
Q

Best test for H. pylori eradication

A

urea breath test

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27
Q

gold standard test for h pylori diagnosis

A

histological examination of antral biopsy

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28
Q

Type 4 gastric ulcers

A

lesser curve high along cardia of stomach; ↓ mucosal protection

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29
Q

Type 1 gastric ulcers

A

lesser curve low along body of stomach; due to ↓ mucosal protection

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30
Q

mutation associated with hereditary diffuse gastric Ca

A

CDH1 mutation (AD)

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31
Q

Types of chronic gastritis

A

● Type A (fundus)
● Type B (antral)

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32
Q

GIST is considered malignant if

A

if > 5 cm or > 5 mitoses/50 HPF (high-powered field)

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33
Q

MALT is associated with

A

H.pylori

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34
Q

dumping syndrome is most common with

A

billroth 2 surgery

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35
Q

Duodenal diverticula are false or true?
congenital or acquired?

A

false
acquired

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36
Q

operative treatment of choice for SMA syndrome?

A

duodenojejunostomy

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37
Q

An aberrant/replaced left hepatic artery originates
from

A

left gastric artery

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38
Q

Borchardt’s triad

A

acute epigastric pain, violent retching without vomiting, and the inability
to pass an NG tube

Associated with gastric volvulus

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39
Q

course of replaced left hepatic artery

A

within the gastrohepatic ligament medially

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40
Q

how to differentiate portal vein from hepatic vein on u/s

A

portal vein have hyperechoic walls

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41
Q

The ligamentum teres

A

extends from
the falciform ligament and carries the obliterated umbilical vein to
the undersurface of the liver

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42
Q

Difference between Hepatic adenoma and focal nodular hyperplasia histologically

A

Hepatic adenoma lacks kupffer cells

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43
Q

screening for HCC

A

done via u/s only every 6 months for patients at risk

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44
Q

The Milan criteria for HCC

A

define HCC tumors in Child’s C cirrhosis
that would benefit from transplantation

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45
Q

Characteristics that further support metastasis over primary
liver cancer include

A

*history of primary cancer
*peripheral residing
lesions
*multiple lesions
* mass hypovascularity (hence only
slightly enhancing compared with adjacent liver parenchyma).

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46
Q

indications for TIPS include

A

*protracted variceal bleeding
*refractory ascites, *hepatic hydrothorax
*Budd-Chiari syndrome refractory to anticoagulation.

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47
Q

preferred site for needle entry in paracentesis

A

3 cm medial and 3 cm superior to the ASIS in the left
lower quadrant (LLQ)

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48
Q

Risk factors for Spontaneous bacterial peritonitis

A

previous SBP
variceal bleeding
low protein ascites

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49
Q

EMPHYSEMATOUS GALLBLADDER DISEASE organism mc involved

A

Clostridium perferignes

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50
Q

Bacterial infection of bile source

A

mostly transferred from portal system

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51
Q

most important cause of late
postoperative biliary strictures

A

Ischemia following laparoscopic cholecystectomy

52
Q

Bile duct strictures without a history of pancreatitis or biliary surgery You think of

A

Biliary cancer

53
Q

Hemobilia

A

fistula between bile duct and hepatic arterial system

54
Q

causes of hemobila

A
  • liver trauma
  • percutaneous instrumentation
55
Q

blood supply to the supraduodenal portion of the bile duct has a
primarily axial or longitudinal pattern. The so-called 3- and
9-o’clock arteries and other small vessels arise from?

A

right
hepatic artery and the retroduodenal artery, which is a branch of
the gastroduodenal artery

56
Q

hepatic synthesis of new bile is around

A

300 to 600 mg/day

57
Q

ileal disease or resection is associated with what type of gallstones

A

pigmented stones

58
Q

The three sonographic
criteria for gallstones

A
  1. hyperechoic intraluminal structure
  2. posterior shadowing
  3. movement of stone with change in position
59
Q

Ventral pancreatic duct form

A

inferior portion of the head of pancreas and the unciate process

connected to duct of wirsung

60
Q

medications associated with pancreatitis

A

azathioprine, furosemide, steroids, cimetidine

61
Q

Type of kidney stones associated with ileostomy and why ?

A

uric acid stones
due to bicarbonate loss

62
Q

Area most likely to perforate in appendicitis

A

Midpoint of antimesenteric border

63
Q

Most common cause of ACUTE abdominal pain in the 1st trimester pregnancy

A

appendicitis

64
Q

intramucosal colon cancer

A

high grade dysplasia within muscularis mucosa (considered carcinoma in-situ as there is no invasion of basement membrane)

65
Q

Rectal cancer can metastasis directly to bone via

A

Batson’s plexus

colon ca does not typically go to bone

66
Q

best test for T and N status for rectal Ca

A

endorectal u/s

67
Q

Apex of tube pointing towards on AXR for sigmoid vs cecal volvulus

A

sigmoid (pointing toward RUQ)

cecal (pointing toward LUQ)

68
Q

Perforation with ulcerative colitis mc site

A

Transverse colon

69
Q

Perforation with Crohn’s mc site

A

distal ileum

70
Q

conditions that Gets better with colectomy

A

most ocular problem
Arthritis
anemia

71
Q

Most two common causes of large bowel obstruction

A
  1. cancer
  2. Diverticulitis
72
Q

localisation studies and their sensitivity for lower GI bleeding

A

● Arteriography – bleeding must be ≥ 0.5 cc/min
● Tagged RBC scan – bleeding must be ≥ 0.1 cc/min

73
Q

Bleeding caused by diverticulosis is venous or arterial

A

arterial

74
Q

bleeding caused by angiodysplasia is venous or arterial

A

venous

75
Q

diverticulum layers

A

only mucosa and serosa
No submucosa

76
Q

Most common complication of diverticulitis

A

abscess formation

77
Q

Typical scenario for ischemic colitis

A

abdominal pain and bright red bleeding per rectum after AAA repair (ligation of IMA)

78
Q

SMA and IMA arise at what vertebral levels

A

SMA– L1
IMA– L3

79
Q

cephalic phase of acid secretion

A

vagal dependent gastric acid secretion in response to food related stimuli (smell, taste, though) before food enters the stomach

80
Q

physical exam findings in anal fissure

A

anodermal split (90% posterior)

sentinel tag

hypertrophied anal papilla

81
Q

what do u seen on exam for rectal prolapse?

A

See full-thickness rectal wall with concentric rings protruding on exam

82
Q

Anal cancer is associated with

A

HPV (16 and 18), HIV, XRT, and immunosuppression

83
Q

Nodal drainage of superior and middle rectum

A

IMA nodes

84
Q

nodal drainage of inferior rectum

A

mainly IMA nodes, also to internal iliac nodes

85
Q

Anal canal (above dentate line)

A

internal iliac nodes

86
Q

anal margin (below dentate line)

A

inguinal L.N

87
Q

pharyngeal cancer that goes to anterior cervical L.N

A

Hypopharyngeal SCCA

88
Q

painful parotid mass is highly suggestive of

A

malignancy

89
Q

Cleft lip time of repair

A

Repair at 10 weeks, 10 lb, Hgb 10.

90
Q

Cleft palate repair

A

Repair at 12 months

may affect speech and
swallowing if not closed soon enough; may affect maxillofacial growth if closed too
early → repair at 12 months

91
Q

which type of CAH is salt wasting

A

21 beta hydroxylase deficiency

92
Q

which CAH has decrease testosterone levels

A

17 hydroxylase deficiency

93
Q

best test for diagnosing pheochromocytoma

A

24 hour urine metanephrines

94
Q

radioactive iodine ablation only work for which type of cancer

A

papillary and follicular
(the well-differentiated thyroid cancers)

95
Q

Thyroglobulin serum levels is used to follow up what cancer

A

papillary and follicular
(the well-differentiated thyroid cancers)

96
Q

pathology of hurthle cell ca thyroid shows

A

Ashkenazi cells.

97
Q

sestamibi scan does not work with

A

4-gland hyperplasia

98
Q

difference in flow between ICA and ECA

A
  • Normal (ICA) has continuous forward flow (biphasic signal, fast
    antegrade, then slower diastolic antegrade signal).
  • Normal(ECA) has triphasic flow (antegrade, retrograde, then
    antegrade again).
99
Q

1st branch of external carotid artery

A

superior thyroid artery

100
Q

1st branch of internal carotid artery

A

Ophthalmic artery

101
Q

CEA indications

A

symptomatic > 50%
asymptomatic > 70% stenosis

102
Q

most common cranial nerve injury with CEA

A

Vagus nerve

103
Q

DeBakey classification
for aortic dissection

A
  • Type I – ascending and descending
  • Type II – ascending only
  • Type III – descending only
104
Q

paraplegia cause during repair of descending thoracic aortic surgery

A

caused by spinal cord ischemia due to occlusion of intercostal arteries and
artery of Adamkiewicz that occurs with descending thoracic aortic surgery

105
Q

most common organism in graft infection following AAA repair

A

S.epidermidis

106
Q

Mycotic aneurysm

A

Bacteria infect atherosclerotic plaque, cause aneurysm.

107
Q

Leg compartments and their associated structures

A
  • Anterior – deep peroneal nerve (dorsiflexion, sensation between 1st and 2nd toes),
    anterior tibial artery
  • Lateral – superficial peroneal nerve (eversion, lateral foot sensation)
  • Deep posterior – tibial nerve (plantar flexion), posterior tibial artery, peroneal artery
  • Superficial posterior – sural nerve
108
Q

what do u know about hunter’s canal lower extremity

A

SFA exits this canal
and it is covered by the sartorius muscle

109
Q

similar to ABPI but more accurate in patients with calcified vessel walls

A

toe pressure/Brachial pressure index
TBI

110
Q

most common site for diabetic foot ulcers

A

2nd MTP (metatarsal head) joint most common

111
Q

when to consider prophylactic fasciotomy

A

for ischemia > 4–6 hours

112
Q

which leg compartment is most likely to be affected by reperfusion compartment syndrome

A

Anterior leg compartment

hence the most common finding are foot drop and loss of sensation between first and second toes because deep peroneal nerve is affected

113
Q

the most common site of
peripheral obstruction from emboli.

A

Common femoral artery at bifurcation of SFA and profunda is the most common site

114
Q

Normal subclavian vein course

A

passes anterior to the anterior scalene muscle

115
Q

Normal subclavian artery and brachial plexus course

A

passes between the anterior and middle scalene muscles

The plexus is behind the artery

116
Q

Most common causes of visceral ischemia:

A
  • Embolic occlusion – 50%
  • Thrombotic occlusion – 25%
  • Nonocclusive mesenteric ischemia (NOMI) – 15%
  • Venous thrombosis –5%
117
Q

Median arcuate ligament syndrome

A

Causes celiac artery compression

118
Q

Migrating thrombophlebitis is associated with

A

Pancreatic cancer

119
Q

cisterna chyli is at what vertebral level

A

L2

120
Q

a lung lesion is considered a solitary pulmonary nodule and not a mass when its size is less than

A

3 cm

121
Q

Most common site of lung cancer mets

A

brain

122
Q

types of lung cancers are broadly divided into

A

Non-small lung ca
Small lung ca

123
Q

paraneoplastic of squamous cell cancer

A

PTHrp

124
Q

Paraneoplastic syndrome of small cell lung cancer

A

ACTH and ADH

125
Q

Most common site for lung abscess

A

RLL

126
Q
A

Residency (5 decks)

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