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Residency > Absite review (2) > Flashcards

Absite review (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
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2
Q

Lymphatic drainage of adrenal medulla

A

Lymphatics drain to subdiaphragmatic and renal lymph nodes.

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3
Q

GFR zones of adrenal cortex

A

SALT, SUGAR and SEX STEROIDS

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4
Q

cortisol effect

A

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

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5
Q

Aldosterone secretion is stimulated by

A

1.angiotensin 2
2. hyperkalmeia
3. to some extent ACTH

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6
Q

which CAH is salt wasting

A

21-hydroxylase deficiency

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7
Q

which CAH has low testesterone

A

17-hydroxylase deficiency

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8
Q

MC cause of primary hyperaldosteronism (Conn’s syndrome)

A

bilateral idiopathic adrenal hyperplasia
(Renin is low)

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9
Q

Causes of secondary adrenal hyperplasia

A

CHF, Renal artery stenosis, Renin secreting tumor…etc
(Renin is high)

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10
Q

patient with HTN and hypokalemia u think of

A

Hyperaldosternism (Conn’s syndrome)

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11
Q

Dx for primary hyperaldosteronism

A
  1. Salt-load suppression test (best, urine aldosterone will stay high)
  2. Aldosterone:renin ratio > 25
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12
Q

MCC of hypocortisolism (addison disease)

A

withdrawal of exogenous steroids

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13
Q

Cosyntropin test

A

give ACTH and measure cortisol level

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14
Q

hypotension not responding to fluids or pressors think of

A

Acute adrenal insufficiency

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15
Q

MC cause of hypercortisolism (cushing’s syndrome)

A

Exogeneous steroid intake

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16
Q

best test to diagnose cushing syndrome

A

24- hour urinary cortisol level (best) , ACTH

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17
Q

high dose dexamethasone suppression test effect on ectopic producer of ACTH

A

does not suppress

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18
Q

cushing’s disease (not syndrome) refers to

A

pituitary adenoma

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19
Q

MC noniatrogenic cause of hypercortisolism

A

pituitary adenoma

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20
Q

rate limiting enzyme in catecholamines production

A

tyrosine hydroxylase

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21
Q

enzymes that converts norepinephrine into epinephrine is only found in

A

adrenal medulla

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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.

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23
Q

10% rule of pheochromocytoma

A

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

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24
Q

preoperative management in pheochromocytoma

A

good volume resuscitation

give alpha blocker before beta blocker

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25
Q

Most common extramedullary tissue site for pheochromocytoma

A

organ of Zuckerkandl

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26
Q

superior and middle thyroid veins drain

A

internal jugular vein

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27
Q

inferior thyroid vein drain

A

innominate (brachiocephalic vein)

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28
Q

MC injured nerve following thyroidectomy

A

superior laryngeal nerve

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29
Q

Tubercles of Zuckerkandl of thyroid

A

most posterio-lateral extension of thyroid gland

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30
Q

thyroglobulin function

A

stores T3 and T4 in colloid within follicular cells

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31
Q

Thyroxine binding protein function

A

transport protein that binds most of T3 and T4 in plasma

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32
Q

Wolf-Chaikoff effect

A

patient given high doses of iodine
(Lugol’s solution, potassium iodide) ihbit T3 and T4 release
(used in Thyroid Storm)

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33
Q

Most thyroid nodules are benign (T or F)

A

true

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34
Q

best initial test for thyroid nodules

A

FNA and TFT

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35
Q

nodules that warrant FNA (according to size)

A

nodules 5mm or more

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36
Q

colloid tissue on thyroid nodule FNA, whats next

A

most likely colloid goiter; low chance of malignancy (< 1%)
* Tx: thyroxine; lobectomy if it enlarges

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37
Q

normal thyroid tissue on FNA with elevated TFT most likely

A

solitary toxic nodule

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38
Q

MCC of goiter worldwide

A

iodine deficiency

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39
Q

Most important aspect before removal of a lingual thyroid

A

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

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40
Q

what hyperthyroid medication is safe in pregnancy

A

PTU

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41
Q

methimazole and PTU MOA

A

Inhibits peroxidases and prevents iodine–tyrosine coupling

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42
Q

causes of hyperthyroidism

A
  1. Graves disease (MC)
  2. Toxi multinodular goiter
    3.single toxic nodule
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43
Q

symptoms that are specific to graves disease

A

exopthalmous
peritibial edema

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44
Q

Graves disease pathogenesis

A

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

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45
Q

MC indication for thyroidectomy in graves disease

A

suspicious nodule

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46
Q

Preop preparation thyroidectomy in graves disease

A

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

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47
Q

preferred initial treatment for toxic multinodular goiter

A

surgery

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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
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49
Q

pathogenesis of hashimotos

A

both cellular and humoral immune mediated

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50
Q

cause of goiter in hashimotos

A

lack of organification of trapped iodide inside gland

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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 syx

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52
Q

Types of thyroid cancer

A
  1. papillary
  2. follicular
  3. medullary
  4. hurthle cell thyroid ca
  5. anaplastic
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53
Q

features worrisome for thyroid malignancy

A

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

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54
Q

MC type of thyroid ca

A

papillary

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55
Q

route of spread of papillary thyroid CA

A

lymphatic

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56
Q

prognosis of papillary thyroid CA based on

A

local invasion

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57
Q

histopathology of papillary CA

A

psammoma bodies
orphan Annie nuclei

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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)

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59
Q

worse prognosis of medullary thyroid CA

A

sporadic type
MEN2b

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60
Q

medullary thyroid CA tumor arises from which cells

A

parafollicular c cells

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61
Q

1st manifestation of MEN IIa and IIb

A

Diarrhea (due to calcitonin release from medullary thyroid CA

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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)
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63
Q

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

A

papillary
follicular

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64
Q

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

A

papillary and follicular thyroglobulin level

Medullary : clacitonin level

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65
Q

Most important factor before initiating iodine ablation therapy

A

Make sure TSH is high to facilitate uptake of radioactive iodine

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66
Q

superior parathyroid are formed embryologically

A

4th pharyngeal pouch

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67
Q

inferior parathyroid are formed embryologically

A

3rd pharyngeal pouch

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68
Q

anatomy of superior parathyroid gland

A

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

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69
Q

anatomy of the inferior parathyroid gland

A

below inferior thyroid artery
medial to the RLN

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70
Q

MC location of ectopic parathyroid gland

A

tail of thymus

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71
Q

Osteitis fibrosa cystica

A

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

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72
Q

labs in primary hyperparathyrodism

A

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

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73
Q

secondary hyperparathyroidism is seen in

A

renal failure patients

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74
Q

“Synchronous” tumors

A

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

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75
Q

Metachronous tumors

A

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

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76
Q

sestamibi scan

A

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

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77
Q

Familial hypercalcemic hypocalciuria pathogensis

A

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

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78
Q

pseudohypoparathyroid
pathogenesis

A

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

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79
Q

Diarrhea is often the presenting symptom in what MEN syndromes

A

MEN2a
MEN2b
(due to increased calcitonin from medullary thyroid CA)

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80
Q

MEN1(MENIN gene)

A

(3Ps)
pituitary adenoma
parathyroid hyperplasia
pancreatic neuroendocrine tumor

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81
Q

MEN2a (RET proto-onco gene)

A

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

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82
Q

MEN2b (RET proto-onco gene)

A

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

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83
Q

PTHrP secreted by which CA

A

squamous cell lung CA
Breast CA

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84
Q

Long thoracic nerve innervates

A

innervates serratus anterior; injury results in winged scapula

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85
Q

Lateral thoracic artery supply

A

supplies serratus anterior

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86
Q

Thoracodorsal nerve innervated

A

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

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87
Q

Thoracodorsal artery supply

A

supplies latissimus dorsi

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88
Q

Medial pectoral nerve innervate

A

innervates pectoralis major and pectoralis minor

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89
Q

Lateral pectoral nerve innervates

A

pectoralis major only

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90
Q

Intercostobrachial nerve

A

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

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91
Q

breast arterial supply

A

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

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92
Q

Mondor’s disease

A

superficial vein thrombophlebitis of breast

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93
Q

green/yellow/brown nipple discharge consistent with

A

fibrocystic disease of the breast

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94
Q

fibrocystic disease of the breast types

A

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

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95
Q

DCIS subtypes and the most aggressive of them all

A

comedo, papillary, cribriform, solid

comedo most aggressive

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96
Q

screening for breast cancer has decreased mortality by

A

25%

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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
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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
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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

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100
Q

MC solitary pulmonary nodule

A

Granuloma, hamartoma

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101
Q

persistant air leaks occurs after which type of thoracic surgeries

A

wedge
segmentectomy

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102
Q

lung cancer prognosis based on

A

nodal invlovement

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103
Q

types of lung cancer

A

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

Small cell carcinoma

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104
Q

Small cell CA paraneoplastic syndrome

A

ACTH and ADH

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105
Q

MC paraneoplastic syndrome ever

A

ACTH secreting small lung CA

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106
Q

unresectable lung disease according to stag

A

N2, N3 or M disease

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107
Q

how does lung hamartomas appear on
CT

A

calcification appear as popcorn lesion

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108
Q

Anterior mediastinal tumors

A

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

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109
Q

posterior mediastinal tumors

A

Enteric cysts
neurogenic tumors
lymphoma

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110
Q

phases of empyema development

A

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

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111
Q

Massive hemoptysis

A

> 600cc/24hr

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112
Q

spontaneous pneumothorax occurs more at which side

A

Right

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113
Q

surgery for pneumothorax

A

VATS apical blebectomy and mechanical pleurodesis

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114
Q

Catamenial pneumothorax

A

occurs in temporal relation to
menstruation
* Caused by endometrial implants in the visceral lung pleura

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115
Q

Ductus arteriosus

A

connection between descending aorta and left pulmonary artery (PA)

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116
Q

Ductus venosum

A

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

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117
Q

MC ASD type

A

ostium secundum

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118
Q

TOF components

A
  1. VSD
  2. Pulmonary stenosis
  3. RV hypertrophy
  4. Overriding aorta
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119
Q

medication used to close a PDA

A

indomethacin

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120
Q

Left main coronary branches

A

Left anterior descending
circumflex

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121
Q

Organisms responsible for endocarditis

A

staph aureus (50% of cases)

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122
Q

Stages of atherosclerosis

A

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

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123
Q

carotid sheath contains

A

carotid artery, internal jugular vein, vagus nerve

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124
Q

MC site of carotid artery stenosis

A

bifurcation

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125
Q

first branch of internal carotid artery

A

ophthalmic artery

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126
Q

Gastrin produced by

A

G cells in stomach antrum

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127
Q

secretion of gastrin is stimulated by

A

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

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128
Q

secretion of gastrin is inhibited by

A

pH < 3.0, somatostatin, secretin, CCK

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129
Q

Target cells for gastrin

A

parietal cells and chief cells

130
Q

effect of gastrin

A

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

131
Q

somatostatin produced by

A

mainly produced by D (somatostatin) cells in stomach
antrum

132
Q

secretion of somatostatin is stimulated by

A

acid in the duodenum

133
Q

target cells of somatostatin

A

Many cells !!
it is the great INHIBITOR

134
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

135
Q

octreotide MOA

A

somatostatin analogue

136
Q

CCK produced by

A

produced by I cells of duodenum

137
Q

secretion of CCK stimulated by

A

amino acids and fatty acid chains

138
Q

effect of CCK

A

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

139
Q

Secretin is produced by

A

S cells of duodenum

140
Q

secretion of secretin is stimulated by

A

fat, bile, pH < 4.0

141
Q

secretion of secretin is inhibited by

A

pH > 4.0, gastrin

142
Q

effect of secretin

A

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

143
Q

Vasoactive intestinal peptide produced by

A

pancreas and gut

144
Q

secretion of VIP is stimulated by

A

fat, acetylcholine

145
Q

effect of VIP hormone

A

increase water and electrolyte intestinal secretion

increase gut motility

146
Q

glucagon is secreted by

A

alpha cells of the pancreas

147
Q

glucagon release is stimulated by (starvation state)

A

↓ glucose, ↑ amino acids, acetylcholine

148
Q

glucagon release is inhibited by

A

↑ glucose, ↑ insulin, somatostatin

149
Q

effect of glucagon

A

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

150
Q

insulin is secreted by

A

beta cells of the pancreas

151
Q

secretion of insulin is stimulated by (fed state)

A

glucose, glucagons, CCK

152
Q

secretion of insulin is inhibited by

A

somatostatin

153
Q

Motilin is produced by

A

Mo cells in the upper small bowel

154
Q

bowel recovery in order

A
  • Small bowel 24 hours
  • Stomach 48 hours
  • Large bowel 3–5 days
155
Q

Peristalsis phases of bowel

A
  • I – resting
  • II – accelerating
  • III – peristalsis
  • IV – decelerating
156
Q

esophageal lining is made up of

A

non-keratinized squamous cell epithelium

157
Q

muscle types of the esophagus

A

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

158
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

159
Q

venous drainage of the esophagus

A

hemi-azygous and azygous veins in the chest

160
Q

left vagus travels

A

anteriorly

161
Q

right vagus travels

A

posteriorly

162
Q

length of esophagus

A

around 25 cm

163
Q

length between the incisors and lower esophageal sphincter

A

around 40 cm

164
Q

Anatomic areas of esophageal narrowing

A
  • Cricopharyngeus muscle
  • Compression by the left mainstem bronchus and aortic arch
  • Diaphragm (near lower esophageal sphincter)
165
Q

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

A

liquid

166
Q

plummer vinson syndrome

A

esophageal web, iron deficiency anemia

167
Q

zenkers diverticulum is what type of diverticulum

A

False diverticulum

168
Q

where is zenker’s diverticulum located

A

located posteriorly;
Occurs between superior pharyngeal constrictors and inferior cricopharyngeus
(Killian’s triangle)

169
Q

causes of zenker’s diverticulum

A

failure of UES to relax leading to an increase in pressure

170
Q

Traction esophageal diverticulum is true or false

A

True

171
Q

epiphrenic diverticulum is true or false

A

false

172
Q

pathogenesis of achalasia

A

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

173
Q

difference between diffuse esophageal spasm and nutcracker esophagus

A

manometry for DES high amplitude NON-peristaltic movements

for nutcracker high amplitude peristaltic movements

174
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

175
Q

best test to diagnose GERD

A

24 hour pH probe

176
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)

177
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

178
Q

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

A

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

179
Q

risk factors for esophageal adenocarcinoma

A

GERD, obesity, Barrett’s

180
Q

MC esophageal CA

A

adenocarcinoma

181
Q

degrees of esophageal caustic injuries

A
  • Primary burn – hyperemia
    Secondary burn – ulcerations, exudates, and sloughing
    Tertiary burn
182
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
(superificial)

183
Q

TIVA (total intravenous anaesthesia) advantage

A

reduce postoperative nausea and vomiting

184
Q

ligasure can seal vessels up to

A

7mm in diameter

185
Q

harmonic scalpel vs ligasure

A

harmonic scalpel uses ultrasound vibration

ligasure uses thermal energy

186
Q

MC hepatic artery variant

A

right hepatic artery comes off SMA

187
Q

line that divides liver into right and left lobe

A

Cantlie’s line

188
Q

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

A

falciform ligament

189
Q

portal triad and gallbladder are found in which liver segments

A

IV, V

190
Q

kupffer cells

A

liver macrophages

191
Q

Foramen of Winslow borders

A
  • Anterior – portal triad
  • Posterior – IVC
  • Inferior – duodenum
  • Superior – liver (caudate lobe)
192
Q

Most primary and secondary liver tumors are supplied by

A

hepatic artery

193
Q

usual energy source for liver

A

ketones

194
Q

the only water-soluble vitamin stored in the liver

A

b12

195
Q

primary bile acids (cholic and chenodeoxycholic) are made by

A

Bile salts are conjugated to taurine or glycine

196
Q

deficiency in storage ability; high conjugated bilirubin

A

Rotor’s syndrome

197
Q

deficiency in secretion ability; high conjugated bilirubin

A

Dubin–Johnson syndrome

198
Q

urgent liver TXP listing if

A

King’s College criteria are met.

199
Q

Budd–Chiari syndrome

A

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

200
Q

Child-Pugh Score depends on what parameters

A

Albumin
Bilirubin
INR
Encephalopathy
Ascites

201
Q

MELD score depends on what parameter

A

uses INR, creatinine, and total bilirubin

202
Q

splenic vein thrombosis can lead to what type of varices

A

Gastric varices

203
Q

MC organism causing pyogenic abscess

A

Ecoli

204
Q

preop ERCP done in liver hydatid cyst to

A

check for communication with the biliary system

205
Q

Most common benign hepatic tumor

A

Hemangioma

206
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

207
Q

Metastasis:primary ratio of malignant liver tumors

A

20:1

208
Q

MC malignant liver cancer

A

HCC

209
Q

MC risk factor for HCC

A

hep B

210
Q

tumor marker for HCC

A

AFP

211
Q

calot triangle border

A

superior liver
medial common hep duct
lateral cystic duct

212
Q

cystic artery is a branch off

A

right hepatic artery

213
Q

gallbladder has no

A

submucosa

214
Q

histopathology with cholecystitis

A

Rokitansky–Aschoff sinuses

215
Q

bile leak after cholecystectomy u think off

A

cystic duct stump
CBD injury
ducts of luschka GB fossa

216
Q

types of GB stones

A

cholesterol stones
black stones
brown stones

217
Q

risk factors for black GB stone

A

hemolytic disorders, cirrhosis, chronic TPN

218
Q

MC location and cause for brown biliary stones

A

CBD
caused by infection in biliary tree

219
Q

Most sensitive test for cholecystitis

A

cholecystokinin cholescintigraphy

220
Q

ACALCULOUS CHOLECYSTITIS risk factors

A

severe burns, prolonged TPN, trauma, or major surgery

221
Q

PRIMARY SCLEROSING CHOLANGITIS is assocaited with

A

ulcerative colitis

222
Q

Adenomyomatosis

A

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

223
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
224
Q

only pancreatic enzymes secreted in its active form

A

amylase

225
Q

pathway of activation of pancreatic enzymes

A

trypsinogen is activated to trypsin by enterokinase secreted by the duodenum

Then trypsin activates EVERYTHING

226
Q

major pancreatic duct that merges with CBD before entering duodenum

A

Duct of Wirsung

227
Q

small accessory pancreatic duct that drains directly into duodenum

A

Duct of Santorini
(s for small duct)

228
Q

Failed fusion of the pancreatic ducts is called

A

PANCREAS DIVISUM

229
Q

MCC death in pancreatitis

A

sepsis

230
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
231
Q

best antibiotic to be given when needed for pancreatitis

A

imipenem

232
Q

ARDS in pancreatitis is related to the release

A

phospholipases

233
Q

Coagulopathy in pancreatitis is related to the release of

A

proteases

234
Q

mnemonic for ON admission ranson criteria

A

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

235
Q

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

A

pancreatic CA

236
Q

MC cause of chronic pancreatitis

A

Alcohol

237
Q

number 1 risk factor for pancreatic adenocarcinoma

A

smoking

238
Q

Pancreatic neuroendocrine tumors are divided into

A

non-functional (MC)
functional

239
Q

MC functional PNET

A

insulinoma

240
Q

symptoms of insulinoma

A

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

241
Q

c-peptide in insulinoma is

A

increased

242
Q

MC PNET in MEN-1

A

gastrinoma

243
Q

MC location of gastrinoma

A

Gastrinoma triangle

244
Q

gastrinoma triangle

A

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

245
Q

symptoms of glucagonoma

A

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

246
Q

symptoms of vipoma

A

watery diarrhea, hypokalemia, and achlorhydria (WDHA)

247
Q

congenital lack of ligaments holding spleen in place is called

A

wandering spleen

248
Q

ITP pathogenesis

A

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

249
Q

THROMBOTIC THROMBOCYTOPENIC PURPURA
(TTP) pathogenesis

A

Due to ADAMTS13 defect (metalloproteinase that normally cleaves
vWF)

platelets go crazy and aggregates

250
Q

Vaccines needed before splenectomy

A

Pneumococcus, Meningococcus,
H. influenzae

251
Q

when to give vaccine in splenectomy

A

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

252
Q

Most common congenital hemolytic anemia requiring splenectomy

A

spherocytosis

253
Q

spherocytosis pathogenesis

A

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

254
Q

which portions of the duodenum are retroperitoneal

A

2nd and 3rd

255
Q

B12 and folate absorption occurn in

A

terminal ileum

256
Q

iron absorption occurs in

A

duodenum

257
Q

both jejunum and ileum are supplied by

A

SMA

258
Q

Arcades and vasa recta difference between ileum and jejunum

A

for jejunum larger fewer arcades with longer vasa recta

259
Q

jejunum and ileum arterial supply

A

SMA

260
Q

non conjugated bile acids are absorbed by

A

passive diffusion

261
Q

how much bowel u need to survive off TPN

A

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

262
Q

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

A

colon Ca

263
Q

failure of closure of the omphalomesenteric duct

A

MECKEL’S DIVERTICULUM

264
Q

most common tissue found in Meckel’s

A

pancreatic tissue

265
Q

when do u remove an incidentally found meckel’s diverticulum

A

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

266
Q

which IBD is more associated with bloody diarrhea

A

UC

267
Q

age of presentation for crohn’s disease

A

bimodal distribution
20–30s, 50–60s

268
Q

extraintestinal manifestations of crohn’s disease

A

1.arthritis
2.uveitis
3.pyoderma gangrenosum
4.megaloblastic anemia

269
Q

MC involved bowel segment in crohn’s

A

terminal ileum

270
Q

histopathology for crohn’s disease

A

transmural inflammation
noncaseating granuloma
cobblestoning
creeping fat
skip lesions
narrow deep ulcers

271
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

272
Q

best for localizing carcinoid tumor not seen on CT scan

A

Octreotide scan

273
Q

Most sensitive tumor marker for carcinoid tumor

A

chromogranin A

274
Q

Peutz–Jeghers syndrome gene mutation

A

STK11 gene mutation; autosomal dominant

275
Q

most common stomal infection

A

candida

276
Q

parastomal hernias is mc associated with

A

colostomies

277
Q

most common cause of stenosis of stoma

A

ischemia

278
Q

FAP+osteomas called

A

Gardner’s syndrome

279
Q

FAP+brain tumors

A

Turcot’s syndrome

280
Q

Peutz–Jeghers syndrome

A

*benign hamartomas
*mucocutaneous pigmentation
*increase risk of breast Ca

281
Q

GIST tumors arise from

A

intestinal calls of cajal

282
Q

ckit mutation of GIST tumors allows which drug to work

A

Gleevec(imatinib)

283
Q

MC location for GIST

A

gastric

284
Q

Anal canal borders

A

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

285
Q

Anal margin border

A

from squamous mucocutaneous junction to 5 cm out radially

286
Q

Ascending and ⅔ of transverse colon blood supply

A

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

287
Q

⅓ transverse, descending colon, sigmoid colon, and upper portion of the rectum blood supply

A

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

288
Q

Marginal artery

A

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

289
Q

Arc of Riolan

A

short direct collateral connection
between SMA and IMA

290
Q

percentage of GI blood flow that supplies mucosa and submucosa

A

80%

291
Q

Middle rectal artery is a branch of

A

internal iliac artery

292
Q

inferior rectal artery is a branch of

A

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

293
Q

Superior rectal vein drain into

A

IMV and eventually the portal vein

294
Q

Middle and inferior rectal veins drain into

A

internal iliac veins and eventually the IVC.

295
Q

Watershed areas of large bowel

A
  • Splenic flexure (Griffith’s point) – SMA and IMA junction
  • Rectum (Sudeck’s point) – superior rectal and middle rectal junction
296
Q

innervation of the external sphincter muscle

A

internal pudendal nerve

297
Q

Stump pouchitis pathogenesis

A

lack of short chain fatty acids

298
Q

Denonvilliers’ fascia (anterior)

A

rectovesicular and rectoprostatic fascia in men;
rectovaginal fascia in women

299
Q

Waldeyer’s fascia (posterior)

A

rectosacral fascia

300
Q

most common colon polyp

A

hyperplastic

301
Q

risk factors for potentially cancerous polyps

A

> 2 cm, sessile, or villous

302
Q

most important prognostic factor for colon CA

A

nodal status

303
Q

FAMILIAL ADENOMATOUS POLYPOSIS (FAP) is associated with what gene mutation

A

APC
autosomal dominant

304
Q

LYNCH SYNDROMES gene mutation

A

DNA mismatch repair gene
also called(hereditary nonpolyposis colon Ca)
autosomal dominant

305
Q

Amsterdam criteria for Lynch syndrome

A

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

306
Q

histopathology of Ulcerative colitis

A

chronic inflammation involving the mucosa and submucosa
CRYPT ABSCSESS

307
Q

complications of U.C

A

Toxic colitis
toxic megacolon

308
Q

Toxic colitis criteria

A

> 6 bloody diarrhea/day
tachycardia
fever
leukocytosis

309
Q

Toxic megacolon criteria

A

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

310
Q

Large bowel perforation with obstruction most likely to occur in

A

cecum

311
Q

Spermatic cord structures rule of 3

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.

312
Q

name spermatic cord structures

A

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

313
Q

Pantaloon hernia

A

direct and indirect components

314
Q

most common early complication following hernia repair

A

Urinary retention

315
Q

most common cause of hernia recurrence

A

Wound infection

316
Q

Recurrence rate of hernia

A

2%

317
Q

Most commonly injured nerve with open inguinal hernia repair

A

ilioinguinal nerve

318
Q

Most commonly injured nerve with laparoscopic hernia repair

A

Lateral femoral cutaneous nerve

319
Q

Femoral canal boundaries

A

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

320
Q

loss of cremasteric reflex; numbness on ipsilateral penis,
scrotum, and thigh after hernia surgery… nerve injured?

A

Ilioinguinal nerve injury

321
Q
A

Residency (6 decks)

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