ABSITE QUEST Flashcards
What would a FDR need to have to warrant your screening at age 40 vs age of onset in FDR (whichever is earlier)?
advanced adenoma (high-grade dysplasia, >/= 1 cm, villous or TV histology, traditional serrated adenoma)
OR
advanced sessile serrated polyp (>/= 1 cm, any dysplasia)
most likely injured vessel during ALIF (esp L5-S1)
left common iliac vein
best imaging for initial w/u of extremity soft tissue sarcoma?
MRI - depth and anatomic relationships
What does PCC contain?
Why not FFP?
Clotting factors 2, 7, 9, 10
FFP takes too much volume and time
Mgmt for chylous ascites?
MCFA –> bowel rest, TPN, octreotide –> surgical ligation
MAP target in septic shock?
65
what is considered cost effective per CDC?
cost of intervention <$50,000 per QALY (quality-adjusted life years gained)
What is Hinchey classification?
0: mild
IA: pericolic inflammation - phlegmon
IB: pericolic/mesocolic abscess
II: pelvic, distant intraabd or intraperitoneal abscess
III: purulent peritonitis
IV: feculent peritonitis
How does ketamine work
Noncompetitive NMDA receptor antagonist that blocks glutamine
Which nerves innervate EAS?
internal pudendal (inf rectal)
S4
In which perianal spaces can a horseshoe abscess form
ishiorectal
intersphincteric
What is the modified hanley procedure? (for horseshoe abscesses)
small incision bw tip of coccyx + anal verge
separate tissues of EAS, drain abscess
seton around sphincter complex
2 lateral counterincisions are made with setons added as well
treatment for supralevator abscess
image-guided closed suction drain placement
What type of anastomosis is avoided in pts with hx diarrhea
coloanal, low colorectal, or ileoanal anastomoses
what’s a full workup for CRC?
CEA
CT C/A/P
Cscope
what timeframe constitutes a CHRONIC anal fissure
6 wks
Ideal diet for chylous ascites?
high protein
low fat
OR TPN +/- somatostatin
describe immune infiltrate of chylous ascites
leukocytosis with lymphocytic predominance
what levels are high in carcinoid syndrome?
5-HIAA
serum chromogranin A
tx for metastatic carcinoid?
(in no order)
1. IR embo
2. surgical debulking
3. ss analogs ie lanreotide
if don’t work alone, can add a tryptophan hydroxylase inhibitor
4. chemo
which cells do carcinoid originate from?
enterochromaffin or kulchinsky cells
__ to __% of carcinoids are found in the lung
10-25%
MC tumor of appendix?
carcinoid
GIST are MC found in the ___
stomach
what do you do for mesenteric cysts?
must excise to prevent recurrence + malignancy risk
- usually don’t need SBR or resection of mesentery but ok to do if very large and compromising mesenteric vasculature
abx for pancreatic necrosis?
carbapenem alone (erta, imipenem)
quinolone/ceftaz/cefepime + metronidazole
in which case would you be ok with FLR…
<20%
<30%
<40%
- healthy liver
- hepatic fibrosis + hepatotoxic chemo
- cirrhosis
what’s assoc with seatbelt sign?
Chance fracture - horizontal fx from post to ant, involving at least 2 columns
(can have paraplegia)
what are obligate glucose users?
RBC
peripheral neurons
neutrophils
adren medulla
what’s a rare but serious complic of rubber band hemorrhoidectomy?
perianal sepsis
tx: EUA with wide debridement + drainage
what kind of org is e coli
aerobic GN rod
MC bacteria in SBP?
- e coli
- streptococcus
anaerobic = uncommon
where does medullary thyroid CA originate?
parafollicular C cells of thyroid
Rome IV criteria for IBS?
recurrent abd PAIN at least 1 day/wk in last 3 months, w/ 2+ of the following:
- related to defecation
- change in freq of stool
- change in form (appearance) of stool
*sx onset at least 6 mo prior to dx
Preop RF for anastomotic leak
male gender
higher ASA class
preop radiation
renal disease
most signif: fecal contamination
(also excess intraop blood loss, >100)
which direction does appendix go with pregnancy?
more anterior
imaging: US … MRI if US can’t see
tx: lap appy (perf appendicitis assoc with 36% chance fetal loss!)
Characteristics of ACC?
irregular, heterogenous
dia >4cm
>20 HU
<50% washout in 10 min (delay)
hypointense compared to liver on T1 MRI
in a patient with leg venous insuff / post-thrombotic syndrome … what do you do and why?
LE venogram
to assess whether venous system (particularly proximally, like iliac) is chronically diseased or stenotic … can stent to improve swelling
MC indication for hysterectomy?
symptomatic uterine fibroids
what is staining of desmoids?
beta catenin
actin
vimentin
negative for:
- cytokeratin
- S100
serum chloride:phosphate ratio should be WHAT for primary hyperPTH?
> 33
s & s of richter hernia?
tenderness + nodularity at surgical scar site … progress quickly to bowel gangrene
in setting of dehydration, what happens to the efferent (renal) arteriole?
vasoconstriction
to maintain glomerular capillary hydrostatic pressure –> maintain normal GFR
what is JGA pathway?
macula densa cells (within JGA) sense low Na –> JGA cells release renin –> activate RAAS –> increase Na + H20 reabsorption
types of fundoplication issues
normal nissen (360): could be too tight
partial: maybe not tight enough
*disrupted: recurrent symptoms (heartburn, regurgitation)
twisted: chest pain, dysphagia, poss GOO
*migrated: won’t really see it and will see hernia (hole)
*slipped: will see it + hernia (hole)
PEH: will see clearly
*likely one of these if having issues 2 months after surgery
what are the chances of siblings being HLA-identical?
25%
only NOA that can be partially removed via HD?
dabigatran
reversal for rivaroxaban? (xarelto)
andexanet alfa
mechanism of action: warfarin
prevent vit K decarboxylation of glutamic residues on vit-K dep factors
screening for FAP pts
*start CRC screening at age 12 - with flex proctosig …
+polyps –> Cscope
-polyps –> repeat q1-2 years
*start UGI tract screening at 20-25 yrs
*annual thyroid screening
women with lynch syndrome … when offer TAH BSO?
at time of colectomy, over 40 yrs, or have finished childbearing
where are carcinoids most likely found?
small intestine
rectum
appendix (if <2cm: appy alone … if >=2cm, involving base, high risk, +LVI: stage –> R hemi + LAD)
tell me about vasopressin (sorry)
V1: vasoconstriction
V2: water R
V3: release of vWf and F8
- released from post pit but made in HYPOTHAL
-ADH stimulated by hypovaolemia and hyperosmolarity
how does p53 work?
tumor suppressor protein
cells with DNA damage –> cell cycle arrest –> DNA repair OR apoptosis
how does bacitracin work
inhibits bacterial cell wall synthesis
side effects: nephrotoxicity (oliguria + edema)
allergic contact dermatitis
what lung volume decreases with morbid obesity?
*decreased in chest wall + lung compliance
- FRC (primarily due to decreased ERV)
- VC
- TLC
how do antifungals work?
amphotericin B: bind to fungal cell wall sterols –> cause lysis
azoles: inhibit fungal cell wall synthesis (critical for cell wall growth)
echinocandin (caspofungin): inhibit fungal cell wall synthesis
how does succinylcholine work?
noncompetitive neuromuscular ACh inhibitor … binds to nicotinic R and causes depol
which is LESS likely to strangulate? direct or indirect hernia
direct hernia - wider neck
odontoid fx (C2)
type 1: upper part of dens - stable
type 2: base of dens - unstable
type 3: extend into C2 vert body - rarely need surgery
surgical procedure for slow transit constipation?
TAC with iliorectal anastomosis
(50-100% success for increasing stool frequency)
causes of acute lower GI bleeding?
Anatomic (diverticulosis)
Inflammatory (IBD)
Neoplastic
Vascular (angiodysplasia, radiation-induced, ischemia)
Iatrogenic (polypectomy)
diverticulosis in high risk pt (persistent bleeding, old, anemia, elevated BUN) … what do you do?
resuscitate –> bowel prep + Cscope asap (within 24 hr)
what is the pathophysiology that can lead to rapid death in open ptx?
collapsed lung 2/2 exposure to atmospheric air, causing severe alteratino of ventilation and venoarterial shuting (V/Q imbalance, respiratory distress)
tell me about ischemic orchitis after inguinal hernia surgery
- presents POD 2-5 (can last up to 12 wks)
- ESP during surgery for RECURRENT inguinal hernia
- thrombosis of pampiniform plexus»_space;> ligation of testicular artery
- tx: anti-inflammatories (NSAIDs) + analgesics (ing nerve block for pain)
*seldom need orchiectomy
*do not re-explore
*do no I&D
changes with alk or acidosis with breathing
hyperventilation –> hypoCO2 –> resp alkalosis
hypoventilation –> too much CO2 –> resp acidosis
what is chronic inguinodynia
postop pain >3 mo after ing hernia repair
tx:
1) PT + oral p meds
2) nerve block
3) respond to block but then have recurrent pain –> triple neurectomy (also remove tacks/mesh after lap surgery ; remove old mesh and replace in preperitoneal space after open surgery)
where are the inguinal nerves located
iliohypogastric: (lies on ant surface of quadratus lumborum and traverses iliacus) between ext and int oblique
ilioinguinal: (traverses the iliacus) over the spermatic cord
fem branch of gf nerve: (more medial course) underside of spermatic cord structures
how is protamine dosed?
1mg for every 100u heparin pt received (half life of heparin is 60-90 min, so also depends on time since heparin was dosed)
can everyone get protamine?
it’s a component of insulin, so diabetics using NPH or insulin aspart protamine may have sensitivity
what meds can cause histamine release?
muscle relaxants
opioids + ketamine
abx (cipro, rifaximin)
preferred method of ureteral repair
- debride tissue
- sptatulated anastomosis with interrupted absorbable sutures
- double J stent
- cover with vitalized tissue when possible
- foley
what decreases risk of electromagnetic interference in pts with implantable cardiac devices?
*ultrasonic devices
- cutting mode
- bipolar > monopolar
where does indirect inguinal hernia sac lie, relative to spermatic cord?
anterior and medial
what are alkylating agents
oxaliplatin
carboplatin
cyclophosphamide
what kind of testicular tumor has elevated AFP?
NONseminomatous
indications for STAT C section
- mother in cardiac arrest
- placental abruption (+/- vag bleeding, +pain)
- nonreassuring fetal HR (severe bradycardia 70-80 or sinusoidal pattern)
normal distance bw rectus muscles
1-2cm
pharmacologic intervention for dumping syndrome?
- acarbose (slows carb digestion)
- octreotide
primary lymphoid organs (generate lymphocytes)
secondary lymphoid organs (initiate adaptive immune response)
liver, bone, thymus
LN, spleen, tonsils, adenoids, Peyer patches
Factor 9 deficiency … what product can you give?
FFP (not Factor 9 concentrate)
Relative CI to PD catheter
peritoneal scarring
physical/psych impairment
anuria
large pt size
active inflamm process
surgical ostomies
VP shunt
lg abd wall hernia
best way to fix an abd wall hernia in setting of peritoneal dialysis plan?
extraperitoneal mesh repair at time of PD catheter placement
what can cause intussusception after IgA vasculitis?
Henoch Schonlein purpura
small bowel wall hematoma
usually ileo-ileal intussusception (vs usual ileocolic)
MCC mortality in cardiac transplant pts after 1 year?
atherosclerosis
best diagnostic scan for colovesicular fistula
CT
how to fix a cardiac injury
pericardiotomy
digital pressure
fix w permanent (prolene) pledget’ed suture, horiz mattress
mechanism underling refeeding syndrome
sudden influx of phosphate into cells –> resumption of ATP
(as aside: develop low K, Mg, Phos 2/2 intracellular shift 2/2 insulin)
rate control agent of choice for COPD (or bronchospasm)
CCB
usual tx for ac joint separation?
nonop w sling
- rarely assoc w brachial plexus injury
- clavicle –> ac jt –> acromion
MCC pseudomyxoma peritoneii?
appendix
best a/c in setting of HIT?
direct thrombin inibitors
- argatroban (metab + excreted by liver)
- bival (also metab by liver by excreted by liver + kidney… prefer for cirrhotics) - L FOR LIVER
HIT - immediate tx?
DC heparin
start alternative a/c (usually direct thrombin inhibitor)
what can a slipped lap gastric band cause?
obstruction
necrosis
erosion
- see fundus above band on UGI
MCC small bowel hemorrhage?
angiodysplasia
For a “biochemical leak” (not true fistula) of pancreas - drain removal?
provider dependent
dont need to wait till amylase normal
TYPES OF PANC FISTULAS
Biochemical leak
Grade B - explain
Grade C - explain
Grade B:
- persistent drainage >3 wks
- req interv
Grade C: need OR for fistula, MOF, death
what is McVay repair?
anchor conjoint tendon to Cooper’s ligament
MC pathogens for ventilator assoc PNA
Staph aureus
Pseudomonas
which steroids for adrenal crisis?
IV hydrocortisone
where are primary bile acids conjugated?
hepatocytes
Explain bile acid life cycle once secreted
80% –> [conjug] absorbed in TI
15% –> deconguj –> absorbed via passive transport in colon
5% –> stool
what are the aminoglycosides?
-micin or -mycin
Risk of wound infection:
clean
clean contaminated
contaminated
dirty
1-5%
3-11%
10-17%
>27%
what hemodynamic changes may you expect with high cervical injuries?
(neurogenic shock)
*hypotension (2/2 art/venous vasodilation) + bradycardia
*due to disruption of sympathetic flow along with unopposed vagal tone
what is spinal shock
loss of SC reflexes below level of injury
MC bacterial infection in cirrhotics
SBP
(–> UTI –> PNA –> skin/soft tissue)
SBP findings + tx
ascitic PMN>500
usually single org (E coli)
tx: 3rd gen cephalosporin like CTX
carcinoid syndrome - which metabolite test in best?
which imaging test?
urine 5HIAA (>25 mg/day)
68Ga-DOTATATE PET/CT
where does carcinoid originate?
Kulchitsky cells (enterochromaffin cells)
issue with CgA for carcinoid?
can be falsely elevated by PPI use
duo ulcer >3cm in HD unstable pt - surgical tx?
controlled duodenal fistula
pyloric exclusion
gastrojejunostomy
how to calculate sodium deficit
(desired Na - pt’s Na) x TBW
TBW = 60% body wt in males VS 50% body wt in females
interferons
- involved in antifungal + antiviral responses
- pro-inflammatory
- major cytokine of wound healing - promote RNA + protein production
Phase 1 wound healing - major cytokines?
“I P M” (inflammation)
TNF-alpha
IL-1
PDGF
Repaired esophageal atresia - most common longterm issue?
dysphagia
Under which Na will you give 3% regardless of volume status?
120
(1) Na<120 OR symptomatic with coma/convulsions
(2) otherwise hyponatremic
mgmt?
(1) 3% hypertonic saline
(2) raise Na by 0.5 mEq/hr
absolute indication for surgery in NEC?
intestinal perforation
which artery is in NAVEL
COMMON femoral artery
what does femoral nerve do?
straightens the legs!
hip flexion + knee extension
what is succinylcholine?
depolarizing, nicotinic ACh-R agonist
rapid onset, short duration
CI to succ
severe extensive burns
crush injury
prolonged immobilization
48-72 hr after denervating injury (stroke, SCI)
NMS disease (ALS, MD, MS)
infection w/ toxin-production (tetanus, botulism)
*severe hyperK –> V fib
do you need bx preop for HCC dx?
no
MC type of appendiceal cancer
NET
what if adenoCA is found incidentally in appendix after lap appy? tx?
R hemi
Thoracic outlet syndrome
- neurogenic (MC - 90%)
- venous
- arterial
Tx?
- aggressive PT
- rib resection + scalenectomy + brachial plexus dissection (+ cervical rib and C7 TP removal if needed)
VENOUS: catheter-directed thrombolysis … after, check for stenosis - if yes, that’s indic for surgery (above)
ARTERIAL: almost always C7 TP or cervical rib. Surgery = reect C7 abnormality + first rib + subclav artery resection/graft
what do you get with …
(1) craniopharyngioma
(2) ependymoma
(3) meningioma
(4) cervical neuroblastoma
(1) bitemporal hemianopia
(2) HA, v, visual loss, b/l babinski
(3) seizure, sensory/motor deficits
(4) Horner syndrome (“PAM”) + neck mass
what are the only 2 aa that are not glucogenic and can be used for ketogenesis?
lysine
leucine
what causes bradycardia during insufflation?
high flow rate CO2 –> peritoneal stretch –> strong+fast vagal response
TRY: slowing insufflation rate
O/W: convert to open
preferred conduit for CABG?
MC used?
PREFERRED: internal mammary (thoracic) arteries
- left –> LAD
- right –> R coronary
MC USED: GSV
vinyl chloride and arsenic –> which CA?
hepatic angiosarcoma
when use Wilcoxon signed-rank test?
nonparametric, paired group
ordinal data (like #’s on a scale (survey etc)) can not be assumed to be normally distributed
MC presentation of …
internal hemorrhoids
external hemorrhoids
internal: prolapse, bleed
external: rupture of vein in inf hemorrhoidal plexus –> acute thrombosis
Tx for below internal hemorrhoids?
grade 1 + 2
gr 2 + 3
gr 3 + 4
gr 1+2 = infrared coagulation; injection sclerotherapy
gr 2+3 = rubber band ligation
gr 3+4 = hemorrhoidectomy
describe stapled hemorrhoidectomy
less painful
higher recurrence rate
MC location for undescended testes?
- superficial inguinal ring
- superficial inguinal pouch
- ing canal
Tx for duo cancer at …
D1
D2
D3
D4
D1, D2: whipple
D3, D4: segmental resection + LAD
histologic appearance of carcinoid (ie appendiceal carcinoid)
polygonal cells with granular eosinophilic cytoplasm
if +mucin containing cells –> goblet cell carcinoid –> R hemi
indics for R hemi (appendical carcinoid)
- > 2cm anywhere
- any size tumor at base
- HG, +margin, mesoappendiceal invasion
- adenoCA
- > 1cm and mixed histology
when tx varices
*non sel BB
*endoscopic band ligation
large (>5mm)
small (<5mm) with red spots
how define clinical signif portal HTN?
hepatic venous pressure gradient >/= 10
for cryptorchidism, after what age do you do orchiopexy?
6 months
what does MMC stand for?
migrating myoelectric complex
can you use the following in pts with PCN allergy?
ertapenem
aztreonam
not really (carbapenem)
yes to aztreonam (monobactam)
calot’s triangle - boundaries?
inf: cystic duct
sup: inf border of liver
right: common hepatic duct
contains: cystic artery
what are the anatomic regions of the CBD?
supraduodenal
retroduo
infraduo
how to dx pheo?
1. plasma free metanephrines (major usefulness - exclude pheo if test results are neg)
#2. if positive –> 24-hr urine collection
when use MIBG for pheo
suspicion for multifocal disease
STARVATION - talk to me
*hepatic glycogen used in in 24 hr.
*at 5-7d of fasting, glucose derives from GNG
*epi, cortisol, glucagon stimulate GNG
*hepatic GNG precursors: alanine, lactate, glycerol, aa/glutamine
*ketone bodies are used as primary fuel source by brain/CNS/heart - not nec as precursor for GNG
how dx barrett esophagus?
EGD + bx (4 quadrant bx every 1-2cm w/in barrett segment)
–> must show columnar epithelium for at least 1cm in distal esoph w/ intestinal metaplasia
mgmt for hydrocele?
usually resolve by age 1-2
if not, ligate patent processus vaginalis (for comm)
components of qSOFA score?
AMS
RR >/= 22
SBP < 100
components of qSOFA score?
AMS
RR >/= 22
SBP < 100
difference bw cutting and coag modes
cutting: continuous, low voltage current .. concentrates energy over a small area, with rapid tissue heating
coag: interrupted (modulated), high voltage current, spreads energy over larger area
blend: modif of cutting – combines cutting + coag. higher blend = more time bw current and greater coag
MC inherited hypercoag disorder
Factor V Leiden
“activated protein C resistance”
*normal: protein C inactiv Factor V (–> prevent coag cascade0
*Factor V Leiden: defective Factor V protein that is resistant to Protein C
at what pt would you consider surgical interv on a fistula?
~12wks (3 months)
–> bowel resection + full thickness excision of fistulous tract
what is workup for testicular mass
scrotal US
LDA, AFP, hCG
if have solid mass –> staging CTs
tx: redical inguinal orchiectomy
rank 3 imaging categories with greatest to lowest radiation exposure
nuclear imaging, cardiac stress test (not bone scan)
PET
CT
MRI - no radiation!
anastomosis … scar has reached __% strength by POD3-4
60%
optimal candidate for MTX, for ectopic pregnancy
- HDS
- no fetal cardiac activity
- hCG = 5000
- willingness to comply post-treatment
is blood supply (inf thyroid) to parathyroids from the medial or lateral side?
medial
MCC PD catheter complic’s overall?
infection
MC noninfectious = outflow failure
^ MCC of that = constipation
When can you not use Tg for surveillance after cancer resection?
if there’s thyroid tissue still present (ie after lobectomy)
What are the 4 types of QI measurements?
outcome measure (measurement of the impact on the person; ie # ppl undergoing wrong site surgery since timeout process) implemented)
process measure (measurement of the ACTIVITIES; freq of timeout done)
structural measures
balancing measure
What kind of surgery has highest rate of postop delirium?
cardiothoracic surgery
(then ortho, general, vascular)
MC site extranodal lymphoma?
RF?
stomach - gastric lymphoma
immunosupp (HIV), H pylori
MC site extranodal lymphoma?
RF?
stomach - gastric lymphoma
immunosupp (HIV), H pylori
Energy sources - temps!
45C (113 F): collagen uncoils and may realine, allowing opposed edges to form covalent bonds + fuse
60C (140 F): irrev protein denat + coag necrosis … blanching
80C (176 F): carbonization .. tissue dries + shrinks … cell death not yet
100C (212 F): vaporization –> cell death
125C (257 F): complete protein+lipid oxidation –> eschar
order of surrogates
spouse
adult child
parent
adult sibling
what is energy required during lactation?
500 cal / day
absolute CI to PD catheter placement
- severe protein malnutrition
- loss of peritoneal function
- impaired physical mental ability of pt
- active abd infection
- freq epi’s of diverticulitis
what are the 4 core skills of TeamSTEPPS?
mutual support
leadership
communication
situation monitoring
pts >40 yrs old with perf appy … longterm mgmt?
colonoscopy + interval appy
tx for CMV
ganciclovir
foscarnet
cidovir
tx for c diff
- first occurrence
- fulminant
first occurence: oral fidaxomicin or oral vanco
fulminant: oral vanco + iv flagyl
signs of air embolism?
harsh continuous murmur
hypoxemia, hypercarbia
fall in end tidal CO2
what is sensory nerve supply of epiglottis?
upper: GP nerve (GAG reflex)
lower + laryngeal mucosa above vocal cords: SLN, internal branch (COUGH reflex)
chronic pancreatitis
gastric varices
no evidence of portal HTN
cause?
splenic vein thrombosis
“sinistral HTN”
definitive mgmt: splenectomy
CI to hepatic resection for HCC, in setting of cirrhosis
- evidence of portal HTN (esoph varices)
- thrombocytopenia
signs of advanced cirrhosis … just go to liver transplant if a candidate
rapid correction results in …
- hypoNa
- hyperNa
hypoNa: ODS (osmotic demyelination syndrome)
*cannot move extremities + dysarthria
hyperNa correction: cerebral edema + brainstem herniation
*decorticate/decerebrate posturing .. cheynes stoke respiration (medulla) .. death
rate control in pt with CHF specifically and afib?
amio
what are immunomodulating agents that decrease rate of infectious complications + shorter LOS
arginine
omega 3 FA (ALA, DHA, EPA)
nucleotides
when do AV sampling?
no lesions on imaging
b/l lesions
b/l hypertrophy
optimal UOP for pts <30 kg (burn)
1-2cc/hr
is there a difference between pylorus preserving whipple v classic whipple (w/ antrectomy) ?
no - surgeon preference
goal CD4 count in HIV person
> 500 is pretty good
<200 assoc with illnesses
3 causes of biliary obstruction (most common first)
gallstones
malignancy
inflammatory stricture (ie from pancreatitis, PSC, Mirizzi)
causes of AG metab acidosis
mudpiles
methanol
uremia
dka
propylene glycol
Isoniazid
lactic acidosis
ethylene glycol
salicylates
what PSA size do you treat, and how?
what makes it complicated?
PSA <2-3cm: serial US q2 wks for 6 wk period
–> if growing, sx, or fail to resolve –> need treatment
PSA >2-3cm: US compression v thrombin injection
Complicated = skin changes, infection, HD instability, neuro changes
how drain paronychia
along perionychial groove (lateral nail groove) after lifting nail plate
air movement with flail chest - during inspiration?
flail chest wall collapses inward, causing air to move to uninvolved side, causing mediastinal shift to uninvolved side
expiration: flail segment balloons out –> air moves towards trachea/bronchi of involved side –> mediastinal shift towards involved side
Heat generated by
ultrasonic
conventional electrosurgery
ultrasonic: 50,000 Hz to cut tissue
up to 200 deg C for hemostasis
conventional electrosurgery: 150-400 deg C
cure for hep C?
sofosbuvir + ribavaran
MC indiction for liver transplant?
HCC
MC reason for unplanned admission after elective general surgery
PONV
30 day mortality rate for elective open repair of TAA is __%
10
inotropes of choice in cardiogenic shock?
dobutamine (unless hypotensive)
dopamine
MC melanoma mutations
V600E
BRAF
treatment for annular pancreas?
surgical bypass
unresectable metastatic melanoma
ipilimumab (+ nivo (aPD-1) if expression is positive)
vemurafenib ONLY for V600E BRAF mutation specifically
predictors of improved pancreatic allograft fxn (4)
donor age <45
donor bmi <30
traumatic cause of death
short preservation time
MCC lymphangitis (org) in ppl with normal immunity
Strep pyogenes
appendicitis signs
iliopsoas (extension of R hip) - retrocecal appendix
obturator sign (internal rotation R hip) - pelvic appendix *can correlate with urinary symptoms
breast cancer
pts with T1-2 cancer (N0, HR+, HER2-) —> recurrence score <10: good. >26: adj chemo
CI to living donor kidney DONOR
diabetes, high HTN, active cancer
BMI>40
GFR<70
pelvic or horseshoe kidney
signif psych impairment causing issues w consent
kidney stones w high chance recurrence (struvite, cysteine)
how to get better visualization of inominate artery injury?
ligate inominate vein
how treat prolactin macroadenoma of pituitary?
medical mgmt first:
cabergoline > bromocriptine (dop agonist)
*trend PRL levels
*repeat MRI in 6-12 months
IF first medical agent ineffective - try another
SURGERY: failure of med mgmt; pregnancy
MC location mets for CRC
- liver
- lung
what are markers of melanoma?
HMB-45
MELAN-A
S100
SOX-10
MITF
MC fungal infection during immunosupp?
aspergillosis
what should AFP level be after HCC resection?
<10
ABSOLUTE CI to lap chole (2)
uncorrected coagulopathy
inability to tolerate pneumoperitoneum
