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ABSITE 2021 > All > Flashcards

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1
Q

Celiac artery branches

A

CHA- RGA, proper hepatic, GDA (RGE and SPD)
LGA
Splenic- LGE

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2
Q

Killians triangle (dz and borders)

A

Zenkers
Inferior constricter mm
Cricopharyngeus

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3
Q

MC esophageal perforation

MC iatrogenic perfortation

A

MC- at GE jxn (usu left) (Boerhaaves)

Iatrogenic- cricopharyngeus

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4
Q

DES vs nutcracker

A

DES- uncoordinated peristalsis

Nutcracker- coordinated high amp contractions

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5
Q

Heller myotomy incision

A

2cm stomach

6cm esophagus

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6
Q

Tx achalasia v DES v nutracker

A

Achalasia- Heller first (dilation or botox if poor sx candidate
DES/Nutracker- CCB and nitrates (long segment myotomy if uncontrolled)

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7
Q

Zenkers v epiphrenic v midesophageal- type, etiology, tx

A

Zenkers- pulsion, failed cricopharyngeal relax, divide cricopharyngeus (+/- remove diverticulum)
Epiphrenic- pulsion, motility DO, diverticulectomy and tx motility DO
Mid- full thickness, inflammatory DO (TB, malignancy), VATS and diverticulectomy

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8
Q

Esophageal CA staging

A

T1a mucosa (EMR if low grade)
T1b submucosa
T2 muscular
T3 adventitia

N1 1-2
N2 3-6
N3 >7

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9
Q

Proximal esophageal CA managmeent

A

> 5cm from cricopharyngeus- esophagectomy

<5cm from cricopharyngeus- definitive chemorads

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10
Q

Tylosis

A

palmar thickening (keratomas)- risk for esophageal SCC

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11
Q

Fanconi anemia

A

SCC esophagus
SCC H&N
pancytopenia

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12
Q

Stomach ulcer classification

A 
I lesser curve
II x2 (1 gastric and 1 prepyloric)
III prepyloric
IV GE jxn
V NSAIDs

II and III are d/t high acid output

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13
Q

Siewert classification

A

I 1-5cm above GEJ
II 1 above and 2cm below GEJ
III <2cm below GEJ

III is the worst prognosis

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14
Q

Forest classification and rebleed risk

A 
IA- brisk bleeding (80%)
IB- oozing
IIA- visible vessel (50%)
IIB- adherent clot (25%)
III- clean ulcer (<5%)
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15
Q

Early and late dumping

A

Early- 20-30min osmolar load

Late- 1-4hr insulin surge

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16
Q

Afferent loop syndrome- acute vs chronic

A

Acute- jaundice, duodenal stump blowout – > emergent surg

Chronic- bacterial overgrowth, B12 deficiency, steatorrhea –> abx, then surgery

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17
Q

CDH1 mutation

A

Autosomal dom
familial gastric cancer (also breast CA)
>18 yo –> prophylactic gastrectomy

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18
Q 
Genes:
Lynch
Juvenile polyposis
Peutz Jeugers
FAP
A

Lynch-MMR
Juvenile- SMAD4
Peutz Jeugers- STK11
FAP- APC

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19
Q

Gastric cancer staging

A 
T1a mucosa
T1b submucosa
T2 muscularis 
T3 submucosa
T4 past submucosa

N1 1-2
N2 3-6
N3 >7

Neoadju for T2 and higher or any nodes (same as esophagus)
Adju for T3 or higher or any nodes

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20
Q

gastric cancer margins, nodes

A

5cm (4cm per NCCN)

15nodes

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21
Q 
Howell Jolly- 
Pappenheimer-
Target cells
Spur cells-
Heinz-
A 
Howell Jolly- nuclear remnants 
Pappenheimer- iron deposits
Target cells- immature
Spur cells- deformed membbranes
Heinz- denatured proteins
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22
Q

highest risk for post splenectomy sepsis

A

beta thalasemia

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23
Q

TTP symptoms

A

FAT RN

fever, anemia, thrombocytopenia, renal failure, neuro changes

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24
Q

Replaced right and left hepatic a

A

Right- SMA (behind panc and CBD)

Left- left gastric (gastrohepatic lig)

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25
Q

Rigler triad

A

bowel obstruction
Stone on imaging
Pneumobilia

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26
Q

gallbladder polyp

A

> 6mm serial ultrasound
10mm chole
Stone + polyp - chole
1.8cm suspicious for cancer

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27
Q

gallbladder cancer RF and staging

A

typhoid, PSC, IBD
T1a lamina propria only
T1b muscularis propria - radical cholecystectomy and portal LAD

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28
Q

isolate gastric varices?

A

splenic v thrombosis (from pancreatitis), tx w splenectomy

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29
Q

portosystemic shunts- pros and cons

A

splenorenal- (wont help w ascites)

portocaval- may make encephalopathy worse and may mess w transplant options

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30
Q

Pyogenic
Amebic
Echinococcal

A

Pyogenic- e coli, drain abx
Amebic- serology dx, flagyl (don’t drain!)
Echinococal- double wall, serology dx, albendazole and excise

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31
Q

MELD vs Child Pugh

A

Child (liver only)- bili, albumin, PT, enceph, ascites

MELD (liver and kidney)- bili, INR, creat (>15 transplant)

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32
Q

Todani classification (and treatment)

A 
1 fusiform (hepaticoJ)
2 saccular diverticulum CBD (RNY choledochojeju)
3 intraduodenal (transduodenal excision, sphincterotomy)
4a intra and extra (hepatic resection, hepaticoJ)
4b extra only (hepaticoJ)
5 intra only (transplant)
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33
Q

Hemangioma v FNH v Adenoma v HCC

A

Hemangioma- “peripheral nodular enhancement” (peripheral to centripetal enhancement), no washout
FNH- stellate scar, arterial homogenous enhancement, kupffer cell uptake
Adenoma- OCP, 10% malignant, >5cm rupture…same imaging as FNH
HCC- hyperdense w fast washout

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34
Q

Kasabach Merritt syndrome

A

Hemangioma DIC

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35
Q

MC liver cancer met

A

Lung

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36
Q

Liver resection percents

A

Healthy 20%
Mild cirrhosis 30%
Cirrhosis 40%
Sig liver dz 50%

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37
Q

Fibrolamellar liver CA

A

young, better prognosis

neurotensin marker

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38
Q

Milan criteria

A

<5cm
<3cm x3
no vascular or extra hepatic spread

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39
Q

Colorectal mets to liver- full response

A

resect still

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40
Q

RAAS pathway

A

Renin (kidney) converts angiotensinogen (liver) –> angiotensin I
ACE (lung) converts angiotensin I –> II
Induces aldosterone production

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41
Q

Medical treatment for hyperaldosterone 2/2 adrenal hyperplasia

A

Spironolactone

Eplrenone

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42
Q

Incidentaloma labs and imaging

A 
cortisol (MN salivary, then 24 hr urine)
catecholamines (plasma, then urine)
Aldoesterone, renin
DHEA (if ACC suspected)
urine androgens (if ACC suspected)

> 10 HF units
<60% washout
6cm

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43
Q

adrenocortical carcinoma- chemo

A

mitotane

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44
Q

Pheo rule of 10%

A 
extraadrenal (MC organ of zuckerkandl at aortic bifurcation)
bilateral
chidlren
familial (VHL, MEN2, NF)
malignant
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45
Q

Pheo imaging

A

CT

MIBG scan if not confirmatory

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46
Q

Stress dose steroids

A

20mg>3wks (none if <3weeks)

none if <5mg/day

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47
Q

MTC in MEN2 thyroidectomy?

A

ppx thyroidectomy at 5yo

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48
Q

pseudocyst intervention criteria

A

> 6cm
symptomatic
enlarging

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49
Q

chronic pancreatitis procedures

A

Puestow- pancreaticoJ
Beger- head resect and pancreaticoJ
Frey- head excavation and pancreaticoJ

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50
Q

“fish mouth papilla”

A

main duct pancreatic duct

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51
Q

branch IPMN- high risk features

A 
>3cm
thick wall
nonenhancing nodules
LAD
main duct >10mm
abrupt main duct change
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52
Q

PNET- symptoms, w/u, management

A

PET>somatostatin scan
Insulinoma- no somatostatin scan, diazoxide for med management; >2cm formal resection
Gastrinoma- >1000 or secretine stim test >200
Glucagonoma- 4D (dermatitis, DM, depression, DVT)
Somatostatinoma- DM, gallstones, steatorrhea
VIPoma- WDHA syndrome

chole if malignant (somatostatin as chemo)

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53
Q

Pancreatiic cancer genes

A

p53

KRAS

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54
Q

Pancreatic cancer resectibility

A

resectable- no arterial contact, <180 SMV or PV
borderline- <180 SMA or celiac, CHA only (no celieac or HAP), reconstructible vein
nonresectable- >180 MSA or celiac

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55
Q

Pancreatic cancer chemo

A

FOLFIRINOX (folinic acid, 5FU, oxetecan/irenotecan, oxaliplatin)

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56
Q

dentate line- separates?

A

upper 2/3 from lower 1/3 of anal canal
columnar (upper) vs squamous (lower)
internal v external hemorrhoids

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57
Q

UC vs crohn’s characteristics

A

UC- crypt abscesses, mucosal

Crohns- fat grandma skipped down wrecked cobbleston; transmural; erythema nodosum

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58
Q

IBD screening

A

8-10 years after dz onsent
then q1-3 yrs
4quad bx q10cm

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59
Q

high risk colorectal cancer screening

A

x1 primary CRC <60yo
x2 primary CRC any age - 40yo, q5y
x1 primary CRC >60yo
x2 secondary CRC any age - 40yo, q10y

FAP 10-12yo q1y
HNPCC 20-25yo, q1-2y

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60
Q

FAP v HNPCC- inheritence, gene, dz

A

FAP- AD, APC, duodenal polyps

HNPCC- AD, MMR, ovarian, endom, bladder, stomach

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61
Q

Amsterdam criteria

A

3 relatives (one is primary relative of other)
2 generations
1 CA<50yo

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62
Q

Cscope adenoma screening f/u

A

tubular adenoma <2x <0.5cm- 5yr
tubular adenoma >3 - 3yr
high risk adenoma >1cm, villous, or high grade- 3yr
hyperplastic - 10yr

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63
Q

Malignant polyps- polypectomy ok?

A

1piece
margins clear
well or mod differentiation
<2mm past mucosa muscularis (if sessile, no submucosal involvement)

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64
Q

colorectal cancer staging

A

Tis lamina propria
T1 submucosa
T2 muscular propria
T3 serosa

T3 stage 2 - rectal neoadju chemoXRT and adju chemo (xtra neoadju chemo if CRM involved b/f surg)
N1 stage 3 - colon adju chemo

N1 - 1-3
N2 3-6
N3 >7

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65
Q

rectal cancer margins

A

2cm distal and 5cm proximal

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66
Q

Neoadju and adju chemorads in CRC

A

Neoadju- 5000 gray, 5FU x 5 weeks

Adju- FOLFOX folinic acid, 5FU, oxaliplatin

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67
Q

EMR of colorectal cnacer

A

T1
<3cm or 1/3 circum
Well or mod differentiation

68
Q

APR v LAR

A

<5cm from anal verge –> APR

69
Q

AIN v Anal cancer tx

A

AIN- imiquimoid or topical 5FU

Nigro- 5FU, mitomycin C, 3000 XRT

70
Q

CEA anatomy (nerves)

A

hypoglossal (lies over bifurcation)
Marginal mandibular nerve (retractor injury; lower lip chin mm)
glossopharyngeal (posterior to bifurcation)
vagus (lateral to ICA/CC)

71
Q

Carotid dz pressures

A

125 - 50%

230 - 80%

72
Q

carotid repair

A

always patch

73
Q

MC mortality after CEA

A

MI (not stroke)

74
Q

When CEA after strokes

A

TIA <2 weeks
moderate stroke 4-6 weeks
Hemorrhagic 6-8 wks
evolving symptoms - emergent

75
Q

BIFFL

A 
1 <25% intimal narrowing
2 >25%
3 pseudoaneurysm
4 complete occlusion
5 transection or active extrav
76
Q

carotid body tumors management

A

resection (dont bx)

77
Q

thoracic outlet

A 
1 subclavian v
2 phrenic n
3 ant scalene
4 subclavian a
5 brachial plexus
6 middle scalene m
7 1st rib
78
Q

thoracic outlet syndrome- symptoms

A 
neurogenic MC
paget schroeder (vein)
79
Q

subclavian steal syndrome

A

subclavian stenosis
reversal of vertebral flow d/t proximal stenosis
subclavian carotid bypass (bypass distal to stenosis)

80
Q

fasciotomies- avoid

A 
superificial peroneal (lateral)- foot eversion
saphenous vein (medial)
81
Q

when to place lumbar drain

A

T8-L1 stent

82
Q

desc thoracic aneursym fix size

A

5.5cm

83
Q

when to fix aneurysms, repair

A 
visceral 2cm (resect and recon)
iliac a 3.5 (endovascular repair)
femoral a 2.5 (resect and interposition)
popliteal a 2cm (exclusion and bypass; look for AAA)
84
Q

AAA repair sizes

A

5.5cm or >1cm/yr

85
Q

MC AAA infection

A

staph aureus for mycotic and graft
(#2 salmonella mycotic)
(#2 e coli for graft)

86
Q

IMA when to reimplant

A

<40 back pressure

87
Q

Leriche syndrome

A

aortiiliac dz (smokers)- butt claudication, decr fem pulses, ED

88
Q

May thurner syndrome (and tx)

A

L iliac v compression; stent

89
Q

fistula rules

A

6 wks
600cc/min
<6mm skin
>6mm diameter

90
Q

rutherford stages

A

I (viable) - basically normal
IIa (threat)- no pulses, partial sensation loss
IIb (threat)- slowed cap return, partial paralysis and sensation loss
III (amp)- nothing

91
Q

endoleak

A

I prox or distal
II lumbars
III limb
IV porosity

92
Q

breast nerves

A 
long thoracic (serratus) winged scapula
thoracodorsal (lat dorsi) weak adduction
93
Q

BIRADS

A 
0 nondiag
1 negative
2 benign 
3 likely benign (6mo f/u)
4 suspicious
5 highly suspicious
6 known malignant
94
Q

Bethesda

A

1 nondx (repeat)
2 benign (repeat 12 mo)
3 AUS/FLUS (repeat FNAB or molec testing)
4 suspicious follicular (molec testing or lobectomy)
5 supsicious malig (total vs lobectomy)
6 malignant

95
Q

phyllodes breast

A

WLE 1cm margins

>5 mphf maliginant concern

96
Q

Gaile model

A 
risk within 5yrs
Age
Menarche
1st child age
Fam hx of breast CA (first degree)
Past breast bx
past hx of atpyical hyperplasia
Race
97
Q

DCIS tx

A

2mm margins

radiation to decr risk of local recurrence

98
Q

breast staging

A

T1 <2cm
T2 2-5cm
T3 >5cm

N1 1-3
N2 4-9
N3 >10

99
Q

breast chemo

A

TAC

taxane, adramycin (doxorubicin), cyclophosphamide (mesma decr risk of hemorrhagic cystitis)

100
Q

inflammatory breast CA

A

AT chemo (adriamycin, taxane) +/- rads
MRM
rads +/- chemo

101
Q

pregnancy breast cancer no nos

A

no cyclophosphamide (AT only)
no transtuzamab
no blue dye

102
Q

pregnancy breast cancer management

A

1st T- BCS not recommended
2nd T- node positive –> MRM or BCS +ALND (rads PP)
node negative –> TM or BCS +SLN (rads PP)

103
Q

atypical lobular hyperplasia

A

WLE (no neg margins needed)

104
Q

thoracic duct course

A

Right –> Left (at T5)

enters into LIJ

105
Q

Type I and II pneumocytes

A

I- gas exchange

II- surfactant

106
Q

MC mediastinal tumors

A

MC - neurogenic tumors (posterior)

MC site = anterior (#1 is thymoma)

107
Q

MC cause of SVC syndrome

A

SCC

108
Q

Lung cancer MC met

A

brain

109
Q

paraneoplastic syndromes of lung CA

A

Squam PTHrP

SCC- ACTH and ADH (MC)

110
Q

MC lung tumors (adult and peds)

A

Adult- SCC (malignant) and hamartoma (benign)

Ped - carcinoid (malig) and hemangioma (benign)

111
Q

PFTs

A

FEV1 >1.5 –> lobectomy
FEV1 >2.0 –> pneumonectomy

VQ scan %PPO FEV1 >40% and TLC >40%

exercise testing VO2 max >15cc/kg/min

112
Q

Vit d processing

A

Vit D –> OH 25 (liver) –» 1,25 OH (kidney)

113
Q

PTH effects

A

clasts –> increase Ca and Phos

Kidney –> calcium reabsorg and decr phos

114
Q

Vit D effects Ca

A

gut increases ca and phos absorb

115
Q

Parathyroidectomy indications

A

Incr Ca
CrCl<60
Tscore <2.5
<50yo

116
Q

palliation for parathyroid cancer

A

bisphos

117
Q

parathyroid where?

A

MC normal location

MC ectopic = thymus

118
Q

External pathway factors

A

VII

WEPT

119
Q

AT III deficciency

A

heparin wont work

Give FFP first

120
Q

factor not made in liver

A

VIII (endothelium)

121
Q

TEG vs ROTEM

A

R time- FFP
K or alpha angle - cryo
Max amp - plt
Lys 30 TXA

Clot time - FFP
MCF - FIBTEM abnormal - cryo
FIBTEM normal - plt

122
Q

alpha v beta receptors

A

alpha - pure vessel constriction

beta- increases heart contractility and HR

123
Q 
CMV and PCP tx
Aspergillus
C krusei
C glabrata
C albicans
A 
CMV - ganciclovir
PCP - bactrim
Aspergillus and C krusei- voriconazole
Glabrata- micafungin
albicans- fluc
124
Q

LCIS- management

A

obs only vs excise (no neg margins needed)

excisional bx to neg margins - pleomorphic or florid

125
Q

neuroendocrine tumors- general rule re tx

A

<2cm - local excision(transanal excision, appy, SBR, etc)

>2cm formal resection (APR, hemicolectomy, WLE SBR)

126
Q

GIST- margins, spread, cell type, tx, MC met

A 
neg margins
hematogenous
intestinal cells of cajal
imatinib
liver
127
Q

SCC skin margins

A

4mm margins

6mm if high risk (>2cm, fat invasion, face/ears/scalp)

128
Q

resp quotient

A

1.0 pure carb
0.8 pure protein
0.7 pure fat
<0.7 starvation

129
Q

VW dz types

A

i and II DDAVP

III give vWF (cryo has some vWF)

130
Q

IPR cell types

A

Inflam 1-7d PMN and MAC
Prolif 1-3wk fibroblasts, collagen depo III –> I
Remod- crosslinking

8 weeks max strength

131
Q 
suprcondylar humerus fx
distal radius fx
anterior shoulder disloc
posterior hip disloc
midshaft humerus fx
A 
supracondylar humerus- brachial a (volkmanns contracture) 
distal radius- median n
anterior shoulder disloc- axillary n
poserior hip- sciatic n
midshaft humerus= radial n
132
Q

Li Fraumeni syndrome

A

sarcoma

breast brain

133
Q

Barretts bx

A

q1cm if mucosal irregularities

q2cm if none

134
Q

DCIS margins

A

2mm

135
Q

SCC margins

A

4mm

6mm for high risk (>2cm, fat invasion, high risk location on face)

136
Q

resp quotients

A

1.0 pure carb
0.8 pure protein
0.7 pure fat
<0.7 starvation

137
Q

vwd disease

A

type i and ii - DDAVP

type III vWF

138
Q

phyllodes margins

A

1cm

139
Q

surgery type and steroid dosing

A

minor- normal steroids
moderate- 50mg IV , then 25 q8h
major 100mg IV, then 50 q8h

140
Q

meckel cell carcinoma-

A

carcinoid of skin

141
Q

evar requirements

A

8-22mm diameter

15-20mm lengh of CIA

142
Q

type i vs type ii error

A 
false positive (nuss is true)
type II- false negative (null is false)
143
Q

pancreas trauma grading

A

grade I and II without duct involvement

144
Q

CBD repair injury

A

within 72hr

145
Q

bismuth classification of cholangiocarcinoma

A

I- common hepatic duct
II at bifurcation
III 2nd biliary ducts 1 side
IV 2 sides

146
Q

vein stripping and high ligation reqs

A

> 8mm or torturous

147
Q

superior laryngeal vs RLN inn

A

SL- cricothyroid

RLN larynx mm

148
Q

clinicAL trial phases

A

1- safe?
2- does it work
3- RCT
4- post market

149
Q

CCK
Secretin
gastrin
GIP

A

G cell antrium- secerte gastrin (gastric acid)
I cells duodenum- secrete CCK (GB contraction, panc enxyame)
S cells duodenum- secretin (panc bicarb)
K duodenum- GIP (inhibigs gastric acid and incr insulin

150
Q

IL1, 2, 4, 6, 8, 10

A 
1- fever, MAC
2 NK cytotoxic cells
4 B cell antibodies
6 APR (hepatic)
8 PMN chemotaxis, angio (neutrophils)
10 stops evertyhing `
151
Q

type I, II, III, IV reactions

A

1 IgE anaphylaxis
2 ABO, IgG, IgM
3 serum sickness
4 t cell mediated (TB, chronic rejection)

152
Q

chromium deficiency

A

hyperglycemia
encephalopathy
nephropathy

153
Q

copper deficiency

A

pancytopenia

154
Q

zinc deficiency

A

wound healing

155
Q

phos deficiency

A

can cause failure to wean
weakness
encephalopathy

156
Q

B1 deficiency

A

Thiamine
CM
Wernickes
Beri Beri

157
Q

B6 deficiency

A

pyrodoxine
siderblastic anemia
glossitis
peripheral neuropathy

158
Q

B12 deficiency

A

megalobastlic anemia
beffy tongue
peripheral neuropathy (will not be seen w folate deficiencY)

159
Q

Niacin deficiency

A

dermatitis
dementia
diarrhea

160
Q

vit E deficiency

A

neuropathy

161
Q

PPV

A

= TP/(TP+FP)

162
Q

NPV

A

= TN/(TN+FN)

163
Q

MEN 1 and 2 gene
FAP gene
Li fraumeni gene

A

MENIN
RET
APC
p53 (sarcoma, breast, brain,, adrenals)

164
Q 
Venurafenlb/fabrafenib
Bervacizumab
Cetuximab
Ipilmumab
Nivolimumab
Pembrolizumab
A 
fenib- BRAF 
BerVacizumab- VEGF (Colon)
Cetuximab (colon)- EGFR
Ipilimumab CTLA4
nivo/pembrolizumab- PD1
165
Q

ptc path

A

psamomma bodies, ophan annie nuclei

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