Brainscape's Knowledge GenomeTM

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


See full index

QUEST > ABSITE QUEST > Flashcards

ABSITE QUEST Flashcards

1
Q

What would a FDR need to have to warrant your screening at age 40 vs age of onset in FDR (whichever is earlier)?

A

advanced adenoma (high-grade dysplasia, >/= 1 cm, villous or TV histology, traditional serrated adenoma)
OR
advanced sessile serrated polyp (>/= 1 cm, any dysplasia)

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

most likely injured vessel during ALIF (esp L5-S1)

A

left common iliac vein

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

best imaging for initial w/u of extremity soft tissue sarcoma?

A

MRI - depth and anatomic relationships

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

What does PCC contain?
Why not FFP?

A

Clotting factors 2, 7, 9, 10
FFP takes too much volume and time

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

Mgmt for chylous ascites?

A

MCFA –> bowel rest, TPN, octreotide –> surgical ligation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MAP target in septic shock?

A

65

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

what is considered cost effective per CDC?

A

cost of intervention <$50,000 per QALY (quality-adjusted life years gained)

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

What is Hinchey classification?

A

0: mild
IA: pericolic inflammation - phlegmon
IB: pericolic/mesocolic abscess
II: pelvic, distant intraabd or intraperitoneal abscess
III: purulent peritonitis
IV: feculent peritonitis

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

How does ketamine work

A

Noncompetitive NMDA receptor antagonist that blocks glutamine

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

Which nerves innervate EAS?

A

internal pudendal (inf rectal)
S4

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

In which perianal spaces can a horseshoe abscess form

A

ishiorectal
intersphincteric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the modified hanley procedure? (for horseshoe abscesses)

A

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

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

treatment for supralevator abscess

A

image-guided closed suction drain placement

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

What type of anastomosis is avoided in pts with hx diarrhea

A

coloanal, low colorectal, or ileoanal anastomoses

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

what’s a full workup for CRC?

A

CEA
CT C/A/P
Cscope

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

what timeframe constitutes a CHRONIC anal fissure

A

6 wks

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

Ideal diet for chylous ascites?

A

high protein
low fat
OR TPN +/- somatostatin

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

describe immune infiltrate of chylous ascites

A

leukocytosis with lymphocytic predominance

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

what levels are high in carcinoid syndrome?

A

5-HIAA
serum chromogranin A

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

tx for metastatic carcinoid?

A

(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

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

which cells do carcinoid originate from?

A

enterochromaffin or kulchinsky cells

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

__ to __% of carcinoids are found in the lung

A

10-25%

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

MC tumor of appendix?

A

carcinoid

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

GIST are MC found in the ___

A

stomach

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

what do you do for mesenteric cysts?

A

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

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

abx for pancreatic necrosis?

A

carbapenem alone (erta, imipenem)
quinolone/ceftaz/cefepime + metronidazole

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

in which case would you be ok with FLR…
<20%
<30%
<40%

A
  • healthy liver
  • hepatic fibrosis + hepatotoxic chemo
  • cirrhosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what’s assoc with seatbelt sign?

A

Chance fracture - horizontal fx from post to ant, involving at least 2 columns
(can have paraplegia)

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

what are obligate glucose users?

A

RBC
peripheral neurons
neutrophils
adren medulla

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

what’s a rare but serious complic of rubber band hemorrhoidectomy?

A

perianal sepsis
tx: EUA with wide debridement + drainage

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

what kind of org is e coli

A

aerobic GN rod

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

MC bacteria in SBP?

A
  1. e coli
  2. streptococcus

anaerobic = uncommon

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

where does medullary thyroid CA originate?

A

parafollicular C cells of thyroid

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

Rome IV criteria for IBS?

A

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

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

Preop RF for anastomotic leak

A

male gender
higher ASA class
preop radiation
renal disease

most signif: fecal contamination
(also excess intraop blood loss, >100)

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

which direction does appendix go with pregnancy?

A

more anterior

imaging: US … MRI if US can’t see
tx: lap appy (perf appendicitis assoc with 36% chance fetal loss!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Characteristics of ACC?

A

irregular, heterogenous
dia >4cm
>20 HU
<50% washout in 10 min (delay)
hypointense compared to liver on T1 MRI

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

in a patient with leg venous insuff / post-thrombotic syndrome … what do you do and why?

A

LE venogram
to assess whether venous system (particularly proximally, like iliac) is chronically diseased or stenotic … can stent to improve swelling

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

MC indication for hysterectomy?

A

symptomatic uterine fibroids

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

what is staining of desmoids?

A

beta catenin
actin
vimentin

negative for:
- cytokeratin
- S100

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

serum chloride:phosphate ratio should be WHAT for primary hyperPTH?

A

> 33

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

s & s of richter hernia?

A

tenderness + nodularity at surgical scar site … progress quickly to bowel gangrene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

in setting of dehydration, what happens to the efferent (renal) arteriole?

A

vasoconstriction
to maintain glomerular capillary hydrostatic pressure –> maintain normal GFR

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

what is JGA pathway?

A

macula densa cells (within JGA) sense low Na –> JGA cells release renin –> activate RAAS –> increase Na + H20 reabsorption

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

types of fundoplication issues

A

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

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

what are the chances of siblings being HLA-identical?

A

25%

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

only NOA that can be partially removed via HD?

A

dabigatran

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

reversal for rivaroxaban? (xarelto)

A

andexanet alfa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

mechanism of action: warfarin

A

prevent vit K decarboxylation of glutamic residues on vit-K dep factors

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

screening for FAP pts

A

*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

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

women with lynch syndrome … when offer TAH BSO?

A

at time of colectomy, over 40 yrs, or have finished childbearing

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

where are carcinoids most likely found?

A

small intestine
rectum
appendix (if <2cm: appy alone … if >=2cm, involving base, high risk, +LVI: stage –> R hemi + LAD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

tell me about vasopressin (sorry)

A

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

how does p53 work?

A

tumor suppressor protein
cells with DNA damage –> cell cycle arrest –> DNA repair OR apoptosis

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

how does bacitracin work

A

inhibits bacterial cell wall synthesis

side effects: nephrotoxicity (oliguria + edema)
allergic contact dermatitis

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

what lung volume decreases with morbid obesity?

A

*decreased in chest wall + lung compliance
- FRC (primarily due to decreased ERV)
- VC
- TLC

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

how do antifungals work?

A

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

how does succinylcholine work?

A

noncompetitive neuromuscular ACh inhibitor … binds to nicotinic R and causes depol

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

which is LESS likely to strangulate? direct or indirect hernia

A

direct hernia - wider neck

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

odontoid fx (C2)

A

type 1: upper part of dens - stable
type 2: base of dens - unstable
type 3: extend into C2 vert body - rarely need surgery

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

surgical procedure for slow transit constipation?

A

TAC with iliorectal anastomosis
(50-100% success for increasing stool frequency)

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

causes of acute lower GI bleeding?

A

Anatomic (diverticulosis)
Inflammatory (IBD)
Neoplastic
Vascular (angiodysplasia, radiation-induced, ischemia)
Iatrogenic (polypectomy)

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

diverticulosis in high risk pt (persistent bleeding, old, anemia, elevated BUN) … what do you do?

A

resuscitate –> bowel prep + Cscope asap (within 24 hr)

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

what is the pathophysiology that can lead to rapid death in open ptx?

A

collapsed lung 2/2 exposure to atmospheric air, causing severe alteratino of ventilation and venoarterial shuting (V/Q imbalance, respiratory distress)

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

tell me about ischemic orchitis after inguinal hernia surgery

A
  • presents POD 2-5 (can last up to 12 wks)
  • ESP during surgery for RECURRENT inguinal hernia
  • thrombosis of pampiniform plexus&raquo_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

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

changes with alk or acidosis with breathing

A

hyperventilation –> hypoCO2 –> resp alkalosis
hypoventilation –> too much CO2 –> resp acidosis

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

what is chronic inguinodynia

A

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)

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

where are the inguinal nerves located

A

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

how is protamine dosed?

A

1mg for every 100u heparin pt received (half life of heparin is 60-90 min, so also depends on time since heparin was dosed)

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

can everyone get protamine?

A

it’s a component of insulin, so diabetics using NPH or insulin aspart protamine may have sensitivity

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

what meds can cause histamine release?

A

muscle relaxants
opioids + ketamine
abx (cipro, rifaximin)

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

preferred method of ureteral repair

A
  • debride tissue
  • sptatulated anastomosis with interrupted absorbable sutures
  • double J stent
  • cover with vitalized tissue when possible
  • foley
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what decreases risk of electromagnetic interference in pts with implantable cardiac devices?

A

*ultrasonic devices
- cutting mode
- bipolar > monopolar

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

where does indirect inguinal hernia sac lie, relative to spermatic cord?

A

anterior and medial

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

what are alkylating agents

A

oxaliplatin
carboplatin
cyclophosphamide

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

what kind of testicular tumor has elevated AFP?

A

NONseminomatous

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

indications for STAT C section

A
  • mother in cardiac arrest
  • placental abruption (+/- vag bleeding, +pain)
  • nonreassuring fetal HR (severe bradycardia 70-80 or sinusoidal pattern)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

normal distance bw rectus muscles

A

1-2cm

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

pharmacologic intervention for dumping syndrome?

A
  • acarbose (slows carb digestion)
  • octreotide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

primary lymphoid organs (generate lymphocytes)
secondary lymphoid organs (initiate adaptive immune response)

A

liver, bone, thymus

LN, spleen, tonsils, adenoids, Peyer patches

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

Factor 9 deficiency … what product can you give?

A

FFP (not Factor 9 concentrate)

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

Relative CI to PD catheter

A

peritoneal scarring
physical/psych impairment
anuria
large pt size
active inflamm process
surgical ostomies
VP shunt
lg abd wall hernia

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

best way to fix an abd wall hernia in setting of peritoneal dialysis plan?

A

extraperitoneal mesh repair at time of PD catheter placement

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

what can cause intussusception after IgA vasculitis?

Henoch Schonlein purpura

A

small bowel wall hematoma

usually ileo-ileal intussusception (vs usual ileocolic)

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

MCC mortality in cardiac transplant pts after 1 year?

A

atherosclerosis

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

best diagnostic scan for colovesicular fistula

A

CT

87
Q

how to fix a cardiac injury

A

pericardiotomy
digital pressure
fix w permanent (prolene) pledget’ed suture, horiz mattress

88
Q

mechanism underling refeeding syndrome

A

sudden influx of phosphate into cells –> resumption of ATP

(as aside: develop low K, Mg, Phos 2/2 intracellular shift 2/2 insulin)

89
Q

rate control agent of choice for COPD (or bronchospasm)

A

CCB

90
Q

usual tx for ac joint separation?

A

nonop w sling
- rarely assoc w brachial plexus injury
- clavicle –> ac jt –> acromion

91
Q

MCC pseudomyxoma peritoneii?

A

appendix

92
Q

best a/c in setting of HIT?

A

direct thrombin inibitors
- argatroban (metab + excreted by liver)
- bival (also metab by liver by excreted by liver + kidney… prefer for cirrhotics) - L FOR LIVER

93
Q

HIT - immediate tx?

A

DC heparin
start alternative a/c (usually direct thrombin inhibitor)

94
Q

what can a slipped lap gastric band cause?

A

obstruction
necrosis
erosion

  • see fundus above band on UGI
95
Q

MCC small bowel hemorrhage?

A

angiodysplasia

96
Q

For a “biochemical leak” (not true fistula) of pancreas - drain removal?

A

provider dependent
dont need to wait till amylase normal

97
Q

TYPES OF PANC FISTULAS
Biochemical leak
Grade B - explain
Grade C - explain

A

Grade B:
- persistent drainage >3 wks
- req interv

Grade C: need OR for fistula, MOF, death

98
Q

what is McVay repair?

A

anchor conjoint tendon to Cooper’s ligament

99
Q

MC pathogens for ventilator assoc PNA

A

Staph aureus
Pseudomonas

100
Q

which steroids for adrenal crisis?

A

IV hydrocortisone

101
Q

where are primary bile acids conjugated?

A

hepatocytes

102
Q

Explain bile acid life cycle once secreted

A

80% –> [conjug] absorbed in TI
15% –> deconguj –> absorbed via passive transport in colon
5% –> stool

103
Q

what are the aminoglycosides?

A

-micin or -mycin

104
Q

Risk of wound infection:
clean
clean contaminated
contaminated
dirty

A

1-5%
3-11%
10-17%
>27%

105
Q

what hemodynamic changes may you expect with high cervical injuries?
(neurogenic shock)

A

*hypotension (2/2 art/venous vasodilation) + bradycardia
*due to disruption of sympathetic flow along with unopposed vagal tone

106
Q

what is spinal shock

A

loss of SC reflexes below level of injury

107
Q

MC bacterial infection in cirrhotics

A

SBP
(–> UTI –> PNA –> skin/soft tissue)

108
Q

SBP findings + tx

A

ascitic PMN>500
usually single org (E coli)
tx: 3rd gen cephalosporin like CTX

109
Q

carcinoid syndrome - which metabolite test in best?
which imaging test?

A

urine 5HIAA (>25 mg/day)
68Ga-DOTATATE PET/CT

110
Q

where does carcinoid originate?

A

Kulchitsky cells (enterochromaffin cells)

111
Q

issue with CgA for carcinoid?

A

can be falsely elevated by PPI use

112
Q

duo ulcer >3cm in HD unstable pt - surgical tx?

A

controlled duodenal fistula
pyloric exclusion
gastrojejunostomy

113
Q

how to calculate sodium deficit

A

(desired Na - pt’s Na) x TBW

TBW = 60% body wt in males VS 50% body wt in females

114
Q

interferons

A
  1. involved in antifungal + antiviral responses
  2. pro-inflammatory
  3. major cytokine of wound healing - promote RNA + protein production
115
Q

Phase 1 wound healing - major cytokines?

“I P M” (inflammation)

A

TNF-alpha
IL-1
PDGF

116
Q

Repaired esophageal atresia - most common longterm issue?

A

dysphagia

117
Q

Under which Na will you give 3% regardless of volume status?

A

120

118
Q

(1) Na<120 OR symptomatic with coma/convulsions
(2) otherwise hyponatremic

mgmt?

A

(1) 3% hypertonic saline
(2) raise Na by 0.5 mEq/hr

119
Q

absolute indication for surgery in NEC?

A

intestinal perforation

120
Q

which artery is in NAVEL

A

COMMON femoral artery

121
Q

what does femoral nerve do?

A

straightens the legs!
hip flexion + knee extension

122
Q

what is succinylcholine?

A

depolarizing, nicotinic ACh-R agonist
rapid onset, short duration

123
Q

CI to succ

A

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

124
Q

do you need bx preop for HCC dx?

A

no

125
Q

MC type of appendiceal cancer

A

NET

126
Q

what if adenoCA is found incidentally in appendix after lap appy? tx?

A

R hemi

127
Q

Thoracic outlet syndrome
- neurogenic (MC - 90%)
- venous
- arterial

Tx?

A
  1. aggressive PT
  2. 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

128
Q

what do you get with …
(1) craniopharyngioma
(2) ependymoma
(3) meningioma
(4) cervical neuroblastoma

A

(1) bitemporal hemianopia
(2) HA, v, visual loss, b/l babinski
(3) seizure, sensory/motor deficits
(4) Horner syndrome (“PAM”) + neck mass

129
Q

what are the only 2 aa that are not glucogenic and can be used for ketogenesis?

A

lysine
leucine

130
Q

what causes bradycardia during insufflation?

A

high flow rate CO2 –> peritoneal stretch –> strong+fast vagal response

TRY: slowing insufflation rate
O/W: convert to open

131
Q

preferred conduit for CABG?
MC used?

A

PREFERRED: internal mammary (thoracic) arteries
- left –> LAD
- right –> R coronary

MC USED: GSV

132
Q

vinyl chloride and arsenic –> which CA?

A

hepatic angiosarcoma

133
Q

when use Wilcoxon signed-rank test?

A

nonparametric, paired group

ordinal data (like #’s on a scale (survey etc)) can not be assumed to be normally distributed

134
Q

MC presentation of …
internal hemorrhoids
external hemorrhoids

A

internal: prolapse, bleed
external: rupture of vein in inf hemorrhoidal plexus –> acute thrombosis

135
Q

Tx for below internal hemorrhoids?
grade 1 + 2
gr 2 + 3
gr 3 + 4

A

gr 1+2 = infrared coagulation; injection sclerotherapy

gr 2+3 = rubber band ligation

gr 3+4 = hemorrhoidectomy

136
Q

describe stapled hemorrhoidectomy

A

less painful
higher recurrence rate

137
Q

MC location for undescended testes?

A
  1. superficial inguinal ring
  2. superficial inguinal pouch
  3. ing canal
138
Q

Tx for duo cancer at …
D1
D2
D3
D4

A

D1, D2: whipple
D3, D4: segmental resection + LAD

139
Q

histologic appearance of carcinoid (ie appendiceal carcinoid)

A

polygonal cells with granular eosinophilic cytoplasm
if +mucin containing cells –> goblet cell carcinoid –> R hemi

140
Q

indics for R hemi (appendical carcinoid)

A
  • > 2cm anywhere
  • any size tumor at base
  • HG, +margin, mesoappendiceal invasion
  • adenoCA
  • > 1cm and mixed histology
141
Q

when tx varices
*non sel BB
*endoscopic band ligation

A

large (>5mm)
small (<5mm) with red spots

142
Q

how define clinical signif portal HTN?

A

hepatic venous pressure gradient >/= 10

143
Q

for cryptorchidism, after what age do you do orchiopexy?

A

6 months

144
Q

what does MMC stand for?

A

migrating myoelectric complex

145
Q

can you use the following in pts with PCN allergy?
ertapenem
aztreonam

A

not really (carbapenem)
yes to aztreonam (monobactam)

146
Q

calot’s triangle - boundaries?

A

inf: cystic duct
sup: inf border of liver
right: common hepatic duct
contains: cystic artery

147
Q

what are the anatomic regions of the CBD?

A

supraduodenal
retroduo
infraduo

148
Q

how to dx pheo?

A

1. plasma free metanephrines (major usefulness - exclude pheo if test results are neg)

#2. if positive –> 24-hr urine collection

149
Q

when use MIBG for pheo

A

suspicion for multifocal disease

150
Q

STARVATION - talk to me

A

*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

151
Q

how dx barrett esophagus?

A

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

152
Q

mgmt for hydrocele?

A

usually resolve by age 1-2
if not, ligate patent processus vaginalis (for comm)

153
Q

components of qSOFA score?

A

AMS
RR >/= 22
SBP < 100

153
Q

components of qSOFA score?

A

AMS
RR >/= 22
SBP < 100

154
Q

difference bw cutting and coag modes

A

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

155
Q

MC inherited hypercoag disorder

A

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

156
Q

at what pt would you consider surgical interv on a fistula?

A

~12wks (3 months)
–> bowel resection + full thickness excision of fistulous tract

157
Q

what is workup for testicular mass

A

scrotal US
LDA, AFP, hCG

if have solid mass –> staging CTs

tx: redical inguinal orchiectomy

158
Q

rank 3 imaging categories with greatest to lowest radiation exposure

A

nuclear imaging, cardiac stress test (not bone scan)
PET
CT

MRI - no radiation!

159
Q

anastomosis … scar has reached __% strength by POD3-4

A

60%

160
Q

optimal candidate for MTX, for ectopic pregnancy

A
  • HDS
  • no fetal cardiac activity
  • hCG = 5000
  • willingness to comply post-treatment
161
Q

is blood supply (inf thyroid) to parathyroids from the medial or lateral side?

A

medial

162
Q

MCC PD catheter complic’s overall?

A

infection

MC noninfectious = outflow failure
^ MCC of that = constipation

163
Q

When can you not use Tg for surveillance after cancer resection?

A

if there’s thyroid tissue still present (ie after lobectomy)

164
Q

What are the 4 types of QI measurements?

A

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

165
Q

What kind of surgery has highest rate of postop delirium?

A

cardiothoracic surgery
(then ortho, general, vascular)

166
Q

MC site extranodal lymphoma?
RF?

A

stomach - gastric lymphoma
immunosupp (HIV), H pylori

166
Q

MC site extranodal lymphoma?
RF?

A

stomach - gastric lymphoma
immunosupp (HIV), H pylori

167
Q

Energy sources - temps!

A

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

168
Q

order of surrogates

A

spouse
adult child
parent
adult sibling

169
Q

what is energy required during lactation?

A

500 cal / day

170
Q

absolute CI to PD catheter placement

A
  • severe protein malnutrition
  • loss of peritoneal function
  • impaired physical mental ability of pt
  • active abd infection
  • freq epi’s of diverticulitis
171
Q

what are the 4 core skills of TeamSTEPPS?

A

mutual support
leadership
communication
situation monitoring

172
Q

pts >40 yrs old with perf appy … longterm mgmt?

A

colonoscopy + interval appy

173
Q

tx for CMV

A

ganciclovir
foscarnet
cidovir

174
Q

tx for c diff
- first occurrence
- fulminant

A

first occurence: oral fidaxomicin or oral vanco
fulminant: oral vanco + iv flagyl

175
Q

signs of air embolism?

A

harsh continuous murmur
hypoxemia, hypercarbia
fall in end tidal CO2

176
Q

what is sensory nerve supply of epiglottis?

A

upper: GP nerve (GAG reflex)
lower + laryngeal mucosa above vocal cords: SLN, internal branch (COUGH reflex)

177
Q

chronic pancreatitis
gastric varices
no evidence of portal HTN

cause?

A

splenic vein thrombosis
“sinistral HTN”
definitive mgmt: splenectomy

178
Q

CI to hepatic resection for HCC, in setting of cirrhosis

A
  • evidence of portal HTN (esoph varices)
  • thrombocytopenia

signs of advanced cirrhosis … just go to liver transplant if a candidate

179
Q

rapid correction results in …
- hypoNa
- hyperNa

A

hypoNa: ODS (osmotic demyelination syndrome)
*cannot move extremities + dysarthria

hyperNa correction: cerebral edema + brainstem herniation
*decorticate/decerebrate posturing .. cheynes stoke respiration (medulla) .. death

180
Q

rate control in pt with CHF specifically and afib?

A

amio

181
Q

what are immunomodulating agents that decrease rate of infectious complications + shorter LOS

A

arginine
omega 3 FA (ALA, DHA, EPA)
nucleotides

182
Q

when do AV sampling?

A

no lesions on imaging
b/l lesions
b/l hypertrophy

183
Q

optimal UOP for pts <30 kg (burn)

A

1-2cc/hr

184
Q

is there a difference between pylorus preserving whipple v classic whipple (w/ antrectomy) ?

A

no - surgeon preference

185
Q

goal CD4 count in HIV person

A

> 500 is pretty good
<200 assoc with illnesses

186
Q

3 causes of biliary obstruction (most common first)

A

gallstones
malignancy
inflammatory stricture (ie from pancreatitis, PSC, Mirizzi)

187
Q

causes of AG metab acidosis

A

mudpiles
methanol
uremia
dka
propylene glycol
Isoniazid
lactic acidosis
ethylene glycol
salicylates

188
Q

what PSA size do you treat, and how?
what makes it complicated?

A

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

189
Q

how drain paronychia

A

along perionychial groove (lateral nail groove) after lifting nail plate

190
Q

air movement with flail chest - during inspiration?

A

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

191
Q

Heat generated by
ultrasonic
conventional electrosurgery

A

ultrasonic: 50,000 Hz to cut tissue
up to 200 deg C for hemostasis

conventional electrosurgery: 150-400 deg C

192
Q

cure for hep C?

A

sofosbuvir + ribavaran

193
Q

MC indiction for liver transplant?

A

HCC

194
Q

MC reason for unplanned admission after elective general surgery

A

PONV

195
Q

30 day mortality rate for elective open repair of TAA is __%

A

10

196
Q

inotropes of choice in cardiogenic shock?

A

dobutamine (unless hypotensive)
dopamine

197
Q

MC melanoma mutations

A

V600E
BRAF

198
Q

treatment for annular pancreas?

A

surgical bypass

199
Q

unresectable metastatic melanoma

A

ipilimumab (+ nivo (aPD-1) if expression is positive)

vemurafenib ONLY for V600E BRAF mutation specifically

200
Q

predictors of improved pancreatic allograft fxn (4)

A

donor age <45
donor bmi <30
traumatic cause of death
short preservation time

201
Q

MCC lymphangitis (org) in ppl with normal immunity

A

Strep pyogenes

202
Q

appendicitis signs

A

iliopsoas (extension of R hip) - retrocecal appendix
obturator sign (internal rotation R hip) - pelvic appendix *can correlate with urinary symptoms

203
Q

breast cancer

A

pts with T1-2 cancer (N0, HR+, HER2-) —> recurrence score <10: good. >26: adj chemo

204
Q

CI to living donor kidney DONOR

A

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)

205
Q

how to get better visualization of inominate artery injury?

A

ligate inominate vein

206
Q

how treat prolactin macroadenoma of pituitary?

A

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

207
Q

MC location mets for CRC

A
  1. liver
  2. lung
208
Q

what are markers of melanoma?

A

HMB-45
MELAN-A
S100
SOX-10
MITF

209
Q

MC fungal infection during immunosupp?

A

aspergillosis

210
Q

what should AFP level be after HCC resection?

A

<10

211
Q

ABSOLUTE CI to lap chole (2)

A

uncorrected coagulopathy
inability to tolerate pneumoperitoneum

QUEST (1 decks)

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