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zAbsite Final 2019 > DECJ > Flashcards

DECJ Flashcards

1
Q

Tx of SIADH

A

fluid restrictiondemeclocycline or vaptans (adh inhibitor)

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2
Q

Portal vein thrombosis tx

A

Control HMHG with variceal ligationAnticoagulate once bleeding controlledConsider distal spleno-renal shunt

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3
Q

MRSA tx

A

vancomycinif vanc resistant then linezolid

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4
Q

VWF

A

binds GP1b on PLTs and attaches them to endothelium

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5
Q

Margin for invasives cancer vs. dcis

A

invasive cancer- gross negativedcis- 1 to 2 mm

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6
Q

Interleukins 1, 2, 4

A

IL1: feverIL2: T cell prolif and Ig productionIL4: T/B cell maturation

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7
Q

Ovarian tumor markers:AFPCEAHCGLDHCa 125Inhibin

A

AFP: yolk sac tumor, endodermal sinusCEA: mucinous ovarian tumorHCG: ovarian choriocarcinoma, embryonal carcinomaLDH: dysgerminomaCa 125: epithelial ovarian tumorsInhibin: granulosa cell tumor

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8
Q

Hormones that increase LES pressure

A

GastrinMotilin

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9
Q

Origin of med thyroid cancer

A

4th pharyngeal arch NCC –> parafollicular C cells

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10
Q

Gardner syndrome

A

epidermal cysts, GI polyposis, osteomas

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11
Q

Indidcations for operative treatment of eso perf

A

early postemetic perforation hemodynamic instability intra-abdominal perforation extravasations of contrast into adjacent body cavities presence of underlying malignancy, obstruction or strictureplace jejunostomy tube for feeding after. don’t place gastric tube (conduit)

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12
Q

Uremic PLT dysfunction

A

2/2 renal diseasereversible dysfunctiontx- ddavp

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13
Q

B12 def

A

megalo anemia, neuropathy

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14
Q

Traction vs. Pulsion Diverticulum

A

traction- inflammation; all 3 layers; mid esopulsion- pressure; 2 layers; above circoph.

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15
Q

Positioning for indirect laryngoscopy

A

sitting upright with a straight back, leaning slightly toward you with chin pointing upward (“sniffing position”)

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16
Q

Kcal per macronutrient

A

protein = 4 kcal/gdextrose = 3 kcal/glipid = 9kcal/gcarb = 4 kcal/g

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17
Q

p53

A

TSG on Ch17cell cycle regulation and apoptosis

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18
Q

Rule of 9s

A

Each arm 9Each leg 18Ant belly 18, Post belly 18Each hand 1Ant face 4.5, Post face 4.5Genitals 1

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19
Q

EBV associated with

A

B cell lymphome (Burkitt)n/ph cancer

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20
Q

FRC

A

Volume of the lung after normal tidal expiration

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21
Q

Cisatracurium

A

non-depolarizingcleared by Hoffman degradationuse in pts w/ renal and hepatic disease

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22
Q

tacro

A

MOA: calcineurin inhibitor (binds fK)s/e- nephrotoxic, p. neuropathy, allopecia

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23
Q

SD

A

1, 2, and 3 SD = 67%, 95%, and 99.7% of the data

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24
Q

Intraductal papilloma

A

MCCO bloody nipple d/ctx w/ duct excisionno increased r/o ca

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25
Q

Blood supply to esophagus

A

Upper 3rd- inferior thryoid arteryMiddle 3rd- thoracic aortaLower 3rd- left gastric

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26
Q

Pleomorphic adenoma

A

MC benign H/N tumormiddle aged womanslow growing; t2 brightTx: superficial parotidectomy even if asx

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27
Q

Rule of 6s

A

flow > 600/mindiameter > 6mm (after placement)depth of 6mm

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28
Q

Comparing pressors

A

Norepi: alpha1 >alpha2,beta1Epi: beta1, alpha1 > beta2, alpha2Phenylephrine: alpha1 > alpha2(no beta)

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29
Q

MCCO of spontaneous bacterial peritonitis

A

E. Coli

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30
Q

Max dose of lido and bupiv

A

lido = 5mg/kg (7 w/ epi)bupiv = 2.5 mg/kgtx- lipid emulsion

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31
Q

Lamivudine

A

rTranscriptase inhibitorTx for hep B at low doses; HIV at high doses

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32
Q

Wound healing order of entry

A

plts → PMNs → macrophages → fibroblast → keratinocytes

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33
Q

5Ts of cyanosis

A

TOF Transposition of GVs Truncus art Tricuspid atresia TAPVC

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34
Q

Pain after inguinal hernia repair

A

Ilioinguinal nerveInjured at external ring. Lies anterior to cordtx- local injection

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35
Q

Staging adrenal cancer

A

s1- <5cms2- >5cms3- n1 or t3s4- mets

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36
Q

location of vagus nerve

A

LARPleft anterior, right posterior to esophagus

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37
Q

Dopamine dosing

A

low- d1/2 ago (renal dose)medium- B agohigh- A ago

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38
Q

LIPID A

A

Gram negative bacteria (Klebsiella)lipopolysaccharide layerendotoxin → septic shock

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39
Q

<p><span>Beta lactamase inhibitors</span></p>

A

<span>Sulbactam/Tazobactam</span><span>Clavulanic acid</span>

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40
Q

Contents of ant triangle

A

Carotid sheath, anca cervicalis, CN 12 (hypoglossal)Contents of carotid sheath: CN10 (vagus), CCA, ICA, internal jugular facial vein is the gateway

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41
Q

BRCA risks

A

female breast, ovarian, male breastI- 60, 40, 1II- 60, 10, 10Women withBRCAbreast CA have the same prognosis stage for stage as non-BRCAbreast CA

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42
Q

Kasabach-Merritt Syndrome:

A

hemangioma + thrombocytopeniausually infantsresect!

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43
Q

Traumatic renal artery thrombosis

A

Unilateral- anticoagulationBilateral- OR or IR stent

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44
Q

Adenoid cystic carcinoma

A

MC minor salivary gland tumor (SM gland)propensity for perineural invasionRemains quiescent for years then metastasizes aggressively

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45
Q

SLNBx for melanoma

A

< .75 mm none> .75 to 1 mm w/ ulceration, mitosis, invasion

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46
Q

Hernia repairs:BassiniMcVayLichtenstein

A

Bassini: CT to ILMcVay: CT to cooper’sLichtenstein: mesh

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47
Q

Casues of increased ETCO2

A

Increased muscle activity (shivering)Increased metabolism (sepsis, fever, malignany hyperT)Increased CODecreased minute ventilation

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48
Q

Acute cellular rejection

A

T cell mediatedpath: portal cellular infiltrate + endotheliitistx: pulse steroids → consider thymo

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49
Q

Phyllodes tumor

A

“sarcoma of the breast”tx- en bloc resectionhematog spread- chemo/LN dissection unnneccesary

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50
Q

Birads 0

A

More imaging: mammogram or targeted US

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51
Q

Mediastinal tumors

A

Anterior: lymphoma MC in children, thymoma MC in adultsMiddle: lymphoma MCPosterior: neurologic MC

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52
Q

Vitamin C

A

hydroxylation of lysine and prolinetype 3 collagen cross-linking

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53
Q

Staph virulence factors

A

protein A: binds Fc component of IgG, forcing variable region to face away from bacterium Enterotoxins: intestines Toxic shock syndrome toxin-1 (TSST-1): superantigen. binds MHC II and T-cell receptor Coagulase: converts fibrinogen to fibrin clot Exfolatins: skin-exfoliating toxins

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54
Q

CN11

A

spinal accessory nerveexit jugulars forameninnervates SCM and trapezius goes along post triangle

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55
Q

Tx of SVC syndrome

A

Angio stenting and steroidsfor sxatic reliefUrgent chemo/rads therapy

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56
Q

Silvadene, mafenide, silver nitrate s/e

A

Silvadene: s/e- neutropenia, hypersensitivity, kernicterus (avoid in preg)Mafenide: psuedomonas coverages/e- met acidosisSilver Nitrate: s/e- hypoNatremia

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57
Q

Indications for radioiodine thereapy

A

2-4 cm massvascular invasionanti-Tg AbTG < 5

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58
Q

Hemophilia A

A

f8 DEFICIENCY SLRMC inherited disordertx- DESMOPRESSIN (mild), f8 concentrate (severe)

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59
Q

Strongest layer of bowel

A

SM

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60
Q

Contents of post triangle

A

CN 11 subclavian arteryEJVbrachial plexus trunks

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61
Q

Paget-Schroetter syndrome

A

Exercise induced thrombosis of subclavian/axillary VEINTx- catheter directed thrombolysis

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62
Q

NEC

A

Bloody stools after 1st feeddx- pneumatosistx- resuscitation, abx; OR if free air, clinical deterioration

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63
Q

Fibroadenoma

A

cyclical paindx- US guided core bxonly excise if discordance with biopsy!

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64
Q

Pancuronium

A

non-depoleliminated by kidney and liver

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65
Q

Location ofsuperior sympathetic block

A

3 to 5 cm in length on the longus capitus muscle anterior to the transverse process of the second, third, and rarely the fourth cervical vertebrae

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66
Q

Order of contents in thoracic outlet

A

vein (SC)phrenicmuscle (scalene)artery (SC)nerve (br plexus)

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67
Q

Insulinoma

A

Loc: throughoutPx: whipple’s triadtx- < 2cm encucleate, >2cm resect

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68
Q

GCS verbal

A

5- normal4- confused3- inappropriate words2- incomprehensible1- none

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69
Q

<p><span>Plasmin</span></p>

A

<p><span>Degrades f5, 8, fibrinogen, and fibrin</span></p>

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70
Q

TXA2

A

vasoconstrictorsreleased by PLTs

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71
Q

Pseudocyst

A

encapsulatedlack epithelial lining>5cm requires drainage

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72
Q

<p><span>Sevoflurane</span></p>

A

fast, less laryngospasm, less pungentgood for mask induction

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73
Q

<p><span>Fibrin</span></p>

A

<p><span>Links Gp2b/3a to form PLT plug</span></p>

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74
Q

NOAC reversak

A

Dabigatran (pradaxa)- Idarucizumab, iHDApixaban- PCC (partial)Rivoroxaban- PCC (partial)

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75
Q

Indications for post op radio-iodine

A

2-4 cmvascular invasionanti-Tg AbTG<5

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76
Q

PEAK and TROUGH

A

PEAK- amountTROUGH- frequency

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77
Q

Desmoid tumor

A

Locally aggressive with no portential for metsTx with resection and chemo

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78
Q

MC vitamind def after REY GB

A

B12

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79
Q

Ulcers:MarginalCameronMarjolin ulcerCushing’s ulcer

A

Marginal- REYGB at GJ anastomosisCameron- on lesser curve of large hiatal herniaMarjolin ulcer- chronic woundCushing’s ulcer- elevated ICP

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80
Q

Products of posterior pituitary

A

“PAO in the POST”ADH, Oxytocin2/2 direct stem from neurosecretory cell

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81
Q

Stage 3 breast cancer and tx

A

3a- 4 to 9 nodes –> consider neoadj for BCT3b- chest wall (not pec wall) or breast skin –> neoadj required3c- supra clavicular nodes –> neoadj required

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82
Q

Tx of GIST

A

Resection w/ gross marginNo LN dissectionAdd imatinib (TK inhibitor) if >5m/50HPF

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83
Q

Non-cyanotic heart defects

A

ASDVSDcoarctation

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84
Q

Bevacizumab

A

recombinant humanizedmonoclonal antibodythat blocks angiogenesis by inhibitingVEGF-A

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85
Q

c/i to BCT

A

multicentricinflammatory cac/i to radiation

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86
Q

<p><span>AT3 Functions</span></p>

A

<p><span>Inhibits thrombin2. Inhibits f9, 10, 11</span></p>

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87
Q

Ranson’s criteria on admission

A

“GA Law” Glu > 200 age > 55 LDH > 350 AST > 250 WBC > 16

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88
Q

Cholangiocarcinoma types

A

1- below confluence2- at confluence3- R or L hep duct4- R and L hep duct5- multicentric

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89
Q

Glycogen

A

stores depleted after 24-48h of starvationMOST found in skeletal muscle, rest in the liver

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90
Q

Types of esophogectomy

A

Transhiatal- laparotomy and cervical incision/anastIvor Lewis- thoracic incisions/anast

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91
Q

type 3 choledochocal cyst

A

choledochoceletx- transduodenal marsupialization or excision

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92
Q

Treatment of colo-cutaenous fistula

A

Start with conservative tx High output: > 500 cc/day –> likely OR Low Output: < 200 cc/dayt –> likely conservative OR if failed after about 6 weeks

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93
Q

CPP

A

MAP - ICPnormal CPP > 60Normal ICP < 20hyperventilation to 35 decreases CO2 causing vascoconstriction and decreasing ICP

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94
Q

Accessible nodal stations w/ EBUS

A

2, 3, 4, 7, 10, 11, 12

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95
Q

tx of Meckels

A

tx- resection if sxs. if appendicits leave Meckel’s alone If no appendicitis take out the Meckel’sOnly consider taking out incidentally found asx Meckel’s in young/healthy ptif bleeding, inflamed or tumor at base –> segmental resection

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96
Q

Hypocalcemia

A

tinglingchvostek/trousseau signEKG- qt prolongation

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97
Q

Angiodysplasia of the colon

A

2nd MC CO gi bleed (vs. div’s)Usually found in cecum and ascending colon

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98
Q

<p><span>Effective for enteroccous</span></p>

A

Ampicillin/AmoxacillinVancomycinTimentin/Zosyn(Resistant to all cephalosporins)

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99
Q

Lateral to medial femoral anatomy

A

Femoral nerveFemoral arteryFemoral veinEmpty space (hernia)Lacunar ligamentSuperficial ring

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100
Q

Gastrin

A

G cells of antrum signal EC cells –> His –> Parietal cell –> HClStimulated by ACh, beta ago, AA

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101
Q

Tx for gallstone ileus

A

Stable and healthy- stone removal and take down fistulaUnstable- stone removal only!

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102
Q

septic shock

A

high CI, low SVR, +/- wedge

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103
Q

Normal SBP in a neonate

A

60-90

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104
Q

How to reach D2 during EGD

A

right rotation and manipulate the up/down control knob

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105
Q

S/e of tamoxifen

A

dvt/peuterine cancer

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106
Q

Best test for resectability and staging of eso cancer

A

Resectability- ctStaging- US

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107
Q

Specific to UC

A

Crypt abscessPsuedopolyps

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108
Q

LeFort fxs

A

I- palateII- nose and palateIII- entire face

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109
Q

Epoteitn

A

stimulated by HYPOXIA produced by kidney fibroblastsLiver is major producer of EPO in fetus

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110
Q

Cutoff for low risk lung nodules not requiring follow-up

A

6mm

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111
Q

Best opioid to use for AKI

A

methadone and fentanyl/sufentanil hydromorphone or oxycodone are used with cautionmorphine and codeine are avoided

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112
Q

<p><span>Anti-staph Penicillins</span></p>

A

OxacillinMethicillinNafcillin

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113
Q

Bile concentration

A

Sodium chloride channels actively transport salt across the epithelium efficientlyand water follows passively in response to the resultant osmotic force

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114
Q

Warthin tumor/Papillary cystadenoma

A

benign tumor of salivary glandoften BILATERAL and 2/2 smokingTx- complete resection with uninvolved margins even if ASx

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115
Q

Hurthle cell

A

Usually benignMUST do lobectomy to diagnosetx- total thyroid if malignant. XRT effective.

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116
Q

Neostigmine

A

reversal of non-depol muscle relaxantsAChE inhibitor

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117
Q

Imaging associated with benign adrenal mass

A

< 10HURapid washout< 4cm

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118
Q

ITP

A

px- petechiae and megakaryotcytestx-steroids (IVIG 2nd line) do not tx unless PLT < 30k or 20k in low risk

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119
Q

Paired vs. unparied t test

A

Paired- compares study subjects at 2 different times (paired observations of the same subject)Unparied-compares two different subjects

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120
Q

Respiratory quotient

A

CO2 produced / O2 consumed>1 → carb is major nutrient.7 → lipids major nutrient

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121
Q

Absolute c/i to spinal anesthesia

A

Infection at the siteHypovolemiaAllergyIncreased ICP

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122
Q

Parkland formula

A

4 x weight x TBSA 1st 1/2 in 1st 8h2nd half next 16

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123
Q

Steps of rapid sequence intubation

A

c-spine stabilize → preO2 → fentanyl → etomidate → succinylcholine

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124
Q

Where to find superior and inferior PD during a whipple

A

Superior:pancreatic headInferior: uncinate process

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125
Q

Tx of Barrett’s

A

low grade dysplasia: repeat scope/bx in 6mhigh grade dysplasia: endoscopic mucosal resection

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126
Q

cyclosporine

A

MOA: calcineurin inhibitors/e- 100x less potent then tacro, nephrotoxic, hypertrichosis, gum hyperplasia

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127
Q

Effective for VRE

A

SynercidLinezolid

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128
Q

Kaposi’s sarcoma

A

HSV8Violet/brown papules

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129
Q

T and N staging eso cancer

A

t1a- LP and MM t1b- SM t2- MP t3- adventitia t4a- resectable structures t4b- unresectable structuresn1: 1-2 nodesn2: 3-6 nodesn3: 7+

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130
Q

CRC T and N

A

t1- SMt2- MPt3- xMP/subserosat4- invaden1- 1-3, n2- >=4

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131
Q

Triple therapy

A

PP1 + 2 antibioticsabxs: amoxicillin, metronidazole, tetracycline, clarithromycin

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132
Q

Chole docho in REY bypass pt

A

w/ GB –> lap chole with CBD exploration –> ERCP through remnantstomachw/out GB –> ERCP with double balloon endoscopt –> ERCP throught remnant stomach

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133
Q

bile salt circulation

A

conjugate in hepatocytes into gly/taurine secreted into bile 80% reabsorbed in ileuim ACTIVELY 20% DECONJUGATED by bacteria deconjugated salts absorbed in colon PASSIVELY 6. 5% is excreted

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134
Q

Howship-Romburg Sign

A

Pain in medial thigh with internal rotation and extensionSuggests an obtruator hernia

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135
Q

MS vs. ED

A

MS- Fibrillin defect (elastin); AD, tall, aortic root dilation, lens defect, arachnodactylyED- t1, t3 , t5 collagen defect; hyper elastic skin, hypermobile joints

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136
Q

Most abundant bacteria in the colon

A

Bacteroides fragiles

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137
Q

Liver lesions on arterial phase: HCC Mets Adenoma Hemangioma FNH

A

HCC- Homogeneous enhancement Mets- Hypoattenuation Adenoma- Heterogeneous enhancement Hemangioma- Periph enhancing FNH- Centrifugal enhancing

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138
Q

Number of lung segments

A

R-10L-8

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139
Q

confounding

A

a variable that influences both thedependent variable and independent variablecausing a spurious association

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140
Q

Epidural hematoma

A

BiconvexMMADOES NOT suture lines

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141
Q

Bethesda criteria for thyroid

A

10 mm is cutoff to get an FNA Non-diagnostic → repeat FNA Benign → follow-up Undetermined significance → repeat FNA Suspicious for follicular neoplasm → lobectomy, repeat FNA, or genetic testing (no core needle) Suspicious for malignancy → lobectomy vs. thyroidectomy Malignant → thyroidectomy

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142
Q

<p><span>Effective for P/A/S</span></p>

A

Ticarcillin (+ticarcillin), Piperacillin (+Zosyn)3/4G cephalosporin (ceftriaxone, cefepime)Aminoglycodies (genta, tobra)FlouroquinolonesMeropenem/Imipenem

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143
Q

HNPCC and criteria

A

HNPCC pts who fulfill Amsterdam clinical criteria for Lynch syndromeCriteria: 3 relatives (one 1st deg)w/ Lynch syndrome-associated cancer (CRC, endometrial, small bowel, ureter/renal) 2 successive generations 1 < 50 yo

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144
Q

MALT lymphoma

A

associated w/ h. Pylori.Tx: Low grade: triple therapy High grade: chemo and XRT (CHOP) +/- rituximab

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145
Q

MCCO chylous ascites

A

malignancy

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146
Q

Gastroschisis

A

GastRoschisis to the Right of midlinerare defects…EXCEPTION- instestinal atResia

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147
Q

Tx of AT3 def

A

Heparin does not work!Tx- recombinant at3 or FFP followed by heparin then warfarin

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148
Q

Indications to tx ICA stenosis

A

if Asx, only tx if > 60if sx, tx if > 50sxs- contralateral motor/sensory sxs, ipsi vision sxs

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149
Q

STSG vs. FTSG

A

STSG- epi + part dermis; worse cosmesis; more contracture! (don’t use over joints)FTSG- epi + dermis; lower survival; more resistant; hypertrophic scar formation; more sensation

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150
Q

ASA

A

irreversible inhibitor of PG metabolism in PLTs2/2 cox acetylation7-days of PLT dysfunction

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151
Q

Tx for beta blocker overdose

A

glucagon

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152
Q

Products of anterior pituitary

A

TSH, ACTH, FSH/LH, GH, Proneurosecretory cell stimulates hypothalamus which lets go of releasing hormone

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153
Q

Rapid coumadin reversal

A

PCC

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154
Q

Pyoderma gangrenosum

A

associated w/ IBDRESOLVES after resectionpre-tibialtx- steroids

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155
Q

Central cord syndrome

A

loss of pain, temp, motormotor UE> LE loss (vs. anterior syndrome)

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156
Q

Scope schedule after Crohn’s dx

A

10 years after dx then every year to r/o dysplasia

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157
Q

TNFa

A

produced by macrophagescauses cachexia

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158
Q

Beckwith Wiedmann Syndrome

A

3m-2yAssociated with hepatoblastoma and wilm’s tumor

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159
Q

type 1 choledochocal cyst

A

fusiform dilationtx- excision w/ REY H-J

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160
Q

<p><span>Cryo</span></p>

A

<p><span>vWF, f8, fibrinogen</span></p>

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161
Q

Breslow depth

A

t1: < 1mm → .5-1 cm margint2: 1-2 mm → 1-2 cm margint3: > 2 mm → 2 cm margin

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162
Q

Best test to dx gastroparesis

A

Scintigraphic gastric emptying

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163
Q

Atlanta classification pancreatits

A
  1. Interstitial: <4w- acute peripanc collection, >4w psuedocyst2. Necrotic: <4w- acute necrotic collection >4w- walled of necrosis
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164
Q

<p><span>FFP</span></p>

A

<p><span>All factors, Protein C and S, AT3</span></p>

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165
Q

Child’s Pugh Score

A

Billirubin, Albumin, INR, Ascites, Encephalopathy

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166
Q

ARDS ratio

A

P/F mild- 200 to 300 moderate 100-200 severe < 100

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167
Q

Orientation of portal triad

A

Bile duct lateralHepatic artery medialPortal vein posterior

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168
Q

Schiatzki’s Ring

A

Associated with hiatal herniaTx- only if sxatic. dilation and PPI; do not resect

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169
Q

MOA reglan and erythromcyin

A

reglan: dopamine antagonisterythromycin: motlin receptor agonist causing SM contraction

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170
Q

indications to bx a neck mass

A

confirm FNA or core needle with excisional biopsy! >1.5 cm enlarged node withoutsigns of infection persistence after trial of antibiotics and observation >2-4 wks increasing size of mass

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171
Q

Peri-op anti-PLT agents

A

Clopidogrel (plavix): hold 5-7 days before elective surgeryASA: continue through the surgery

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172
Q

neurogenic shock

A

high CI, low SVR, low wedge

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173
Q

Indications for iHD

A

GFR 10-15 for sxaticGFR < 5 for asymptomaticSxs = AEIOU (acid, lytes, intox, olverload, uremia)

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174
Q

Breast Cancer in pregnancy

A

1T- MRM. Chemo is not OK.2T/3T- consider BCT. Modfied radio-isotope. Chemo is OK. Post delivery radiation.

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175
Q

Who needs stress dose steroids

A

> 20 mg of steroids for > 3 weeks

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176
Q

Frey syndrome

A

gustatory sweating s/p parotidectomy

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177
Q

Layers of colon/rectum

A
  1. mucosa2. sub-mucosa3. muscularis propria4. serosa
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178
Q

FNH

A

path- CENTRAL STELLATE SCAR!; bright on arterial phase homogenoustx- resect if sxatic. no malignant potential.

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179
Q

TOF

A

Most common cyanotic defectVSD, PS, OA, RVHtx- beta blocker; surgery at 3-6m

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180
Q

Omphalocele

A

2/2 failure of umbo ring closure 11th week gut returns to abdominal cavitynormal bowel (protected)Other congenital defect are more common

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181
Q

Hard signs of vascular injury

A

shockexpanding hematomapulsatile bleedthrill/bruitabsent pulseischemia

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182
Q

Primary lymphoid organ vs. secondary

A

Primary: generate cells i.e. liver, bone, thymusSecondary: maintain cells i.e. nodes, spleen, MALT

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183
Q

Tx of liver lesions:HemangiomaFNHAdenoma

A

Hemangioma: only if sxatic or KM syndrome FNH: NTD Adenoma: < 4cm w/out OCP response or > 4cm

184
Q

s/e of silver nitrate, silver sulfadiazene, mafenide

A

Silver nitrate- eletrolytes disturbace (no sulfa)Silver sulfadizene- neutropenia, sulfaMafenide- met acidosis, sulfa

185
Q

Tx of complete CBD transection

A

REY HJ has better long term outcome than primary repair

186
Q

Indications for neoadjuvant therapy for stomach cancer

A

Any T2 lesion or LN involvementT2: growth into the muscularis propria

187
Q

Number of LN needed for gastric vs. CRC

A

gastric- 15CRC- 12

188
Q

Thyroid ima

A

supplies medial aspect of both lobes of the thyroidcome off the innominate/brachiocephalic

189
Q

long chain vs. medium chain TG

A

LC- absorbed by lymphaticsMC- absorbed into blood

190
Q

Fuel for SB and LB

A

SB- glutamineLB- SCFA

191
Q

Torsades

A

2/2 hypoK, hypoCa, hypoMgall cause qt prolongation

192
Q

Carcinoid vs. GIST origin and tx

A

carcinoid- Kulchinsky cells (enterochromaffin-like) < 2cm –> appendectomy > 2cm –> R hemi chemo if unresectable GIST- cajal cells tx- resection imantinib

193
Q

Thoracic duct course

A

originates at L1-L2 @ c. chylicross from R to L at T4-5empties into L SC/IJ jxn

194
Q

TOF anomalies

A

Over-riding aorta RV hypertrophy VSD RV obstruction

195
Q

Sevoflurane

A

rapid induction, less laryngospasm, less pungentgood for mask inductions/e- expensive, liver metabolism

196
Q

Inidications for neoadjuvant chemotherapy for rectal cancer

A

Stage 2 and aboveStage 2: at least t3 (crossing musc prop) or any n (stage 3)

197
Q

Screening guidelines for breast ca

A

annual screening at age 40

198
Q

<p><span>DDAVP</span></p>

A

<p><span>Cause endothelium to release f8 and vWF</span></p>

199
Q

Iron def

A

anemia, glossitis, brittle nails, cardiomegaly

200
Q

Types of vagotomy

A

Highly selective: only removes innervation to lesser curvature- preserves pylorus → no drainage procedureTruncal vagotomy: removes lesser curve and pylorus nerves (upstream)- need pyloroplasty. high r/o dumping syndrome

201
Q

Vitamin K

A

gamma CARBOXYLATION (not decarb) ofGLUTAMATE on 2, 7, 9, 10, c, s

202
Q

Spigelian hernia

A

found along semilunar line lateral to rectusall should be repaired

203
Q

Ethylene glycol toxicity

A

metabolized in the liveroxalate stones → renal failureanion gap met acid

204
Q

type 4 choledochocal cyst

A

extra/intra dilationstx- excision w/ REH H-J

205
Q

Hyperacute rejection mechanism

A

Host IgG towards class 1 MHC

206
Q

PPV, NPV

A

PPV = of the people who test positive how many have the diseaseNPV = of the people who test negative how many do not have the disease

207
Q

Isoflurane

A

good for neurosurgery; no increase in ICP

208
Q

Indications for neoadjuvant therapy eso cancer

A

t1b and above ORany nodal involvement

209
Q

MCCO healthcare infection: HAP central line infection SSI UTI GI infection

A

HAP: staph central line infection- candida SSI- staph UTI- e. Coli GI infection- c. diff

210
Q

Peutz-Jeghers

A

ADPx- intestinal hamartomas, pigmented oral mucosaStart screening at 25; scope q2 years

211
Q

T and N staging for gastric cancer

A

t1- SMt2- MPt3- xMP/subserosat4- invaden1: 1-2, n2: 3-6, n3: >7

212
Q

MC uni-microbial CO nec fasc

A

Clostridium perfringensgas gangreneanaerobic

213
Q

Calcitonin

A

Parafollicular C cells Inhibits osteoclast resorptionIncreases Ph excretion

214
Q

<p><span>Halothane</span></p>

A

Slow onset/offset.Least pungent (children)s/e:- highest cards depression and arrhythmia- halothane hepatitis

215
Q

types of endoleak and tx

A

1- proximal or distal seal –> emergent!2- back bleeding3- graft defect (tear or overlap leak) –> emergent!4- porosity

216
Q

ASD

A

L to R shuntOstium primum (down syndrome)and secundumParadoxical emboliRepair at 1-2y

217
Q

Atropine

A

competitive inhibitor of ACh at muscarinic receptor liver metabolism

218
Q

Zinc def

A

skin rash, impaired wound healing, testicular atrophy

219
Q

Hepatitis seromarkers

A

Vaccinated: surface Ab POSITIVEResolved Hb infection: surface Ab POSITIVE and core Ab POSITIVEActive infection: surface Ag, surface Ab, and core Ab ALL POSITIVE

220
Q

MCCO Cancer

A

Male- prostate, lung, CRC lung, prostate, CRCWomen- breast, lung , CRC death: lung, breast, CRC

221
Q

Hereditary pancreatitis

A

PRSS1 trypsinogen mut’nADsmoking cessation is important

222
Q

type 2 choledochocal cyst

A

cystic diverticulatx- excision w/ primary closure (NOT a REY)

223
Q

Reversals: BB Tylenol Benzos CN/Nitroprusside Vecuronium/Rocuronium Ethylene glycol Methemoglobinemia

A

BB overdose: fluids/atropine → glucagon Tylenol: NAC Benzos: flumazenil CN/Nitroprusside: sodium thiosulfate, amyl nitrite Vecuronium/Rocuronium: sugammadex Ethylene glycol: femopizole and bicarb OR ethanol; iHD Methemoglobinemia: methylene blue

224
Q

TASC classifcation

A

TASC a and b usually get endovascular repairA- < 3cmB- 3-10 cm

225
Q

Superior laryngeal nerve

A

motor to cricothyroidinjury: high pitch

226
Q

Lipopolysaccharide

A

cell wall of GN bacteria endotoxinactivates complements cascade → sepsis

227
Q

Tylenol metabolsim

A

Glucuronidation(45-55%) Sulfation (sulfate conjugation) (20–30%) N-hydroxylation and dehydration, then glutathione conjugation, (less than 15%) hepaticcytochrome P450enzyme system NAPQI

228
Q

F5 Leiden

A

resistance to protein C and Sacts w/ Xa to converts fibrinogen to fibrin

229
Q

Paget Von Schroetter syndrome

A

narrowing of SC/Ax vein 2/2 mech compressionpx- acute swellingTx- catheter directed thrombolysis (NOT open thrombectomy)

230
Q

Lung fissures

A

Oblique fissure: aka major fissure; separates upper lobe from lower lobe +/- middleHorizontal fissure: aka minor fissure; only on the R; separates upper lobe from middle lobe

231
Q

Treatment of Merkel Cell

A

excisionhighly radiosensitive. radiate if > 2cmSLNBx

232
Q

Mucoepidermoid carcinoma

A

MC malignant H/N tumor

233
Q

Staging GB cancer

A

1a- LP –> just cc’ectomy1b- MM –> cc’ectomy, hepatic/ LN/duct resectiont2- perimuscular CTt3- organs

234
Q

Copper def

A

pancytopenia, myelopathy, pigmentation change

235
Q

CRC staging

A

stage 1- t1 to t2, n0stage 2- t3 to t4, n0stage 3- node involvementstage 4- m1

236
Q

sirolimus

A

MOA: mTOR inhibitors/e- lymphocele, wound complications- lymphcele can cause mesenteric mass and SBObenefit- less nephrotoxic

237
Q

DES

A

unorganized peristalisisnormal LES pressurenormal relaxation

238
Q

Selenium def

A

cardiomyopathy, hypothyroid

239
Q

Clinical trial phase

A

1- determine safe dosing and route2- evaluate effectiveness and side effects3- determine if better than alternatives4- follow individuals for s/e’s

240
Q

Echinoccocus

A

Hydatid cysttx w/ mebendazole

241
Q

Heparin

A

accelerates AT3 activity and INDIRECTLY inhibits thrombin

242
Q

hepatic adenoma

A

path- EARLY HETEROGENEOUS enhancement on A phase w/ rapid washouttx- stop OCP use. resect if > 5cm or sxatic

243
Q

Specific to Crohn’s disease

A

CobblestoningGranulomasTransmural Fistulas

244
Q

Free water deficit

A

TBW x [(Na-140)/140]TBW = weight x .6 (men) or .5 (women)

245
Q

Spinal vs. Epidural

A

Spinal- below l1/l2; SA space; fast; n/m blockEpidural- any level; epidural space; slow; no block

246
Q

Tx SIADH

A

Chronic – Tx: fluid restriction and diuresisAcute – Tx: conivaptan, tolvaptan

247
Q

Rocuronium

A

non-depolrapid onset; best for short procedureseliminated by liver only

248
Q

type 1 vs. type 2 error

A

type 1: false positivetype 2: false negativepower = 1 - type2

249
Q

Periop DM management

A

Oral agents: hold ON THE MORNING of surgery. Resume after surgery (EXCEPT for metformin)Rapid IV agents: withhold while NPO and use with a sliding scaleIntermediate/Long acting: give normal dose the night before Give ½ dose the morning of surgeryPump: keep a basal insulin infusion on the day of surgery - use pump to correct levels as needed

250
Q

T staging indications for neoadjuvant- eso- stomach- colon- rectal

A
  • eso: t1b (SM)- stomach: t2 (MP)- colon: t4b (adjacent organs)- rectal: t3 (through MP)
251
Q

Ureter injuries

A

proximal ⅓ → primary ureterourostomymiddle ⅓ → primary or tran uretero urosotomylower ⅓ → re-implanation +/- hitch

252
Q

Hot vs. cold nodules

A

Hot- surgery or iodine ablation –> unlikely cancerCold- FNA –> may be cancer

253
Q

Post splenectomy ppx

A

“SHiN”PPV23 + haemophilus influenzae TYPE B + meningococcal polysaccharideElectively- 2 weeks beforeEmergently- PPV23 directly postop, other two given 2 w post op

254
Q

Milan criteria

A

indications for trx w/ HCC Single tumor < 5cm No more than 3 tumors each < 3 cm5-year transplant pt survival is 65-90%

255
Q

<p><span>Isoflurane</span></p>

A

Good for neurosurgeryPungent (not used for induction)

256
Q

Hyperkalemia EKG

A

peaked T wave

257
Q

Dexmedetomidine

A

Mech- CNS alpha2 agoNot an induction agent. Good for intubated ptsAnesthesia and analgesias/e- bradycardia

258
Q

MC aortic infections

A

aneurysmal- staphnon-aneurysm- salmonella

259
Q

febrile transfusion rxn

A

RECIPIENTS Ab attack DONOR leukocytes

260
Q

Tx of breast CA in preg

A

partial mastectomy + radiation after preg OR full mastectomytrastuzumab is c/i

261
Q

Octreotide

A

Somatostatin analogueInhibits exocrine function of pancreas and CCK releaseTx for chronic pancreatitis

262
Q

Latent error

A

2/2 condition of system being removedevident after a “perfect storm”

263
Q

Specific to Crohn’s

A

Creeping fatSkip lesionsTransmural

264
Q

Polyps that require surgery instead of endoscopic resection

A

Submucosal invasion > 1mmPoorly differentiated<1 mm marginLymphovascular invasionTumor buddingSessile polyp (if you can’t get it all)

265
Q

Blood supply of pancreas

A

Head: superior PD and inferior PDBody/tail: splenic

266
Q

Mondor disease

A

tender, “cord-like” structuretx- NSAIDs

267
Q

Criteria for transanal excision of adenocarcinoma

A

T0 or T1 (submucosa)< 3 cm< 30% circumferencePalpable on DRE (<8cm from anal verge)

268
Q

Meckel’s Diverticulum

A

Anti-mesenteric border of SB2/2 peristant viteline ductpancreatic and gastric tissue

269
Q

Acetazolamide

A

Inhbitis carbonic anhydraseInterferes with bicarb resorbtion causing non-AG metabolic acidosis

270
Q

hypovolemic shock

A

low CI, high SVR, low wedge

271
Q

Tx for hemobilia

A

angioembolization

272
Q

PFTs for lung resection

A

FEV1 >1.5L lobe, >2L pneumo –> OK for surgeryIf not: lung scanPPO FEV1 > .8L (>40%)PPO DLCO > 10 ml/min/mmHg (>40%)If not: exercise testVO2 > 10 ml/min/kg –> OK for surgery

273
Q

Succinylcholine

A

ONLY depolarizingshort half life and rapid onset (RSI)degraded by plasma CEs/e: rhabdo, ocular HTN, malig hyperthermia, hyperKc/i: spinal cord injury, renal failure, large burns

274
Q

dcis vs. lcis

A

dcis: excisional bx 1mm margin no SLN unless mastectomy lcis: excisional bx marginfor LCIS –> no further intervention. consider hormone tx or ppx mastectomy margin positive for DCIS/invasive ca –> surgery

275
Q

Sarcoma T and N staging

A

T1- <5 cmT2- > 5cmN1- regional nodes

276
Q

<p><span>Etomidate</span></p>

A

Fewer hemodynamic changesFast actingFewest cards s/es/e- adrenocortical suppresion w/ cont infusion

277
Q

basiliximab

A

MOA: IL2 inhibitor

278
Q

Midodrine

A

a1 agonist

279
Q

Li Fraumeni

A

p53 mutationbreast ca + soft tissue sarcoma

280
Q

Tx of Ogilvie’s

A

supportive, dc narcotics, ng tube, neostigmineif > 10cm –> scope decompression and neostimgine failure –> OR

281
Q

MCCO cauti

A
  1. e. coli2. enterococcus3. candida
282
Q

cardiogenic

A

low CI, high SVR, high wedge

283
Q

GCS eye opening

A

4- spon3- to voice2- to pain1- none

284
Q

Dysplasia of any grade in the GI tract

A

polypectomy will sufficeneed to re-scope in 3m if high grade or sessileif there is SM invasion –> surgical resection

285
Q

Markers:Ca 125bHCGAFPInhibin

A

Ca 125- epithelialbHCG- choriocarcinomaAFP- germ cell/endodermal/yolk sacInhibin- granulosa/sex-cord

286
Q

Inguinal hernia nerves

A

Ilioinguinal- MC in open repair; runs ant/top of cord; under EOIliohypogastricGB of GFLateral femoral cutaneous- MC in lap repair; injured laterally

287
Q

Axis of gastric volvulus

A

Organoaxial: rotate around the long/vertical axis Mesenteroaxial: rotate around wide/horizontalaxis

288
Q

neostigmine

A

MOA: increased PS activity (AChE-I)tx for ogilvie’sMONITORED SETTING w/ atropine b/c high r/o BRADYCARDIAb4 r/o mech obsxn 1st or r/o perf b/c of enhanced motility and pressure

289
Q

Somatostatinoma

A

Loc: headPx: DM, gallstones, steatorrhea, block exo/endo pancreas

290
Q

Tx of prolactinoma

A

if sxatic or macroadenoma bromocriptine or carbegoline (both dopa agonists) bromo is safe in pregnancysurgery if failure

291
Q

Sub-acute thyroiditis

A

Recent viral URItx- NSAIDs/steroids

292
Q

Variceal bleeding 2/2 pancreatits

A

Splenic vein thrombosistx- splenectomy

293
Q

VW disease

A

1- low quantity. tx- desmo and cryo2- low quality: tx- only cryo3- complete absence: tx- cryo and desmodx- ristocetin test or measure vWF level

294
Q

Loss in excess weight for each surgery

A

REYGB- 75%SG- 60%Lap band- 50%

295
Q

Gastric ulcers

A

1- lesser curve/antrum; normal acid2- gastric + duo; high acid3- pre pyloric: high acid4- GE junction: normal acid

296
Q

Modified radical mastectomy

A

mastectomy with ALND (level 1 and 2 only) w/ sparing of pectoralis

297
Q

layers of the eso

A

Mucosa epithelium LP MM Sub-mucosa (lots of lyphatics!) MP AdventitiaNO serosa!

298
Q

Duration of treatment - tamoxifen and trastuzumab

A

Tamoxifen- 5yTrastuzumab- 1y

299
Q

F11 def

A

r/o bleeding w/ surgerytx- FFP (not f11 concentrate!)

300
Q

Margin for LE sarcoma

A

2cm

301
Q

Somatostatin

A

D cells in stomach, duo and pancShuts off insulin, glucagon, and gastrinStimulated by acid

302
Q

Stimulation of CCK release

A

fatty acids and amino acidsin thechymeentering theduodenumCCK-releasing proteinACh

303
Q

Order of potency of steroids

A

HC Pred Methylpred Dexameth

304
Q

Cowden’s

A

pten mutationbreast ca + thyroid ca + hamartomas

305
Q

long thoracic nerve vs. thoracodorsal nerve

A

LTN → serratus –> winged scapTD → LD –> difficult shoulder ADduction/Int rotation

306
Q

PLT count trx threhold

A

Stable and non-bleeding –>< 10KStable and non-bleeding with temp > 38 –> < 20kSurgical pt < 50k<20K spontaneous bleeds

307
Q

NNT`

A

NNT = 1/absolute risk reduction (ARR)ARR = event rate in intervention group - rate in null group

308
Q

half-lifeacoags:warhepnoac

A

war - 36hhep 90mnoac- 12h3.5 half lives to ss<p style="text-align: center;"></p>

309
Q

Achalasia

A

no peristalsishigh LES pressureincomplete relaxation

310
Q

MEN syndromes

A

1- panc, pit, PT2a- PT,MTC, pheo2b- pheo, MTC, marfanoid/neuromas

311
Q

Tx of cholangiocarcinoma

A
  1. Upper 3rd- duct resection w/ partial hepatectomy2. Middle 3rd- bile duct resection + LADN3. Lower 3rd- Whipple*Locally advanced/unresectable- transplant
312
Q

Types of Shunts

A

Total: porto-caval, meso-caval<ul style="margin-left:40px;"> Relieves bleeding and ascites More hepatic encephalopathy</ul> Partial: distal spleno-renal<ul style="margin-left:40px;"> Relives bleeding only</ul>

313
Q

Glucagonoma

A

Loc: distalPx: dermatitis, DRH, DM, nec mig erythema

314
Q

<p>MELD</p>

A

Bili INR Creatinine

315
Q

Pancreatic ducts

A

Wirsung- major, lies inferiorSantorini- minor, lies superior

316
Q

Hypokalemia EKG

A

qt prolongation

317
Q

Entamoeba histo

A

MExicotx with MEtronidazole (no OR!)NO rim enhancement (vs. amoebic abscess)dx- EIA (assay)

318
Q

Group A strep

A

strep pyogenessuspect if gas and bullae

319
Q

Imatinib

A

competitive inhibitor of TKtx for GIST

320
Q

Tx of ovarian vein thrombosis

A

AnticoagulationAbx if septic sxs

321
Q

Pyogenic abscess

A

MC- biliary dz and bile obstruction; e. Coli and klebtx- perc drainage is 1st line!

322
Q

clostridium

A

anaerobic, GPRMC CO emphysematous cholecystitisMC CO gas gangrenetx- PCN, clinda 2nd line

323
Q

Light’s criteria

A

PLprotein/serum Pr >.5 PLLDH/serum LDH > .6 PL LDH > 2/3 ULN

324
Q

Tx of psuedocyst

A

<6cm and <6w –> conservative>6cm and >6w –> drain if sxatic (perc cath, endoscopic methods, or surgery)

325
Q

Arterial content

A

(1.34 x Hb x Sa02) + (.003 x PaO2)

326
Q

tx of eso cancer by t stage

A

t1a- mucosal resectiont1b- esophagectomyt2- esophagectomyt3- esophagectomyt4a- esophagectomyt4b- chemo/radscervical- chemo/rads

327
Q

FAP screening and treatment

A

Scopes annually starting at 10-12y life-long screening for APC carriers. Can stop at 40 if not APC carrierIndications for colectomy Suspected colorectal cancer Severe symptoms High-grade dysplasia Multiple adenomas larger than 6 mm Marked increases in polyp number on consecutive exams Inability to adequately survey the colon because of multiple diminutive polyps

328
Q

Stewart-Treves syndrome

A

post mastectomy lymphangiosarcomarare and highly malignantTx- wide local excision w/ 3-6 cm margin

329
Q

Fibrinogen

A

binds gp2b/3a receptors to link PLTs together

330
Q

Ranson’s criteria at 48 h

A

“C and Hobbs” Ca < 8 HCT down > 10 pts O2 < 60 Base deficit > 4 BUN > 5 Sequestration of fluids > 6L

331
Q

Hemangioma

A

path- PERIPHERAL ENHANCEMENTtx- if rupture, size change, or KM syndrome

332
Q

Drainage of gonadal veins

A

R- IVCL- L renal vein

333
Q

T staging for HCC

A

T1: any size without vascular invasionT2: < 5 cm with vascular invasionT3: > 5 cm with vascular invasionT4: invade adjacent organs

334
Q

Indications of breast MRI

A

high risk women occult breast cancer

335
Q

T staging for esophageal cancer

A

t1a- muscularis mucosat1b- SMt2- muscularis propriat3- adventitia*no serosa

336
Q

Halothane

A

cheapesteffective at low concentrations/e- ventricular arrhythmia, hepatic necrosis

337
Q

Stress induced gastritis

A

Stress elevated AChACh –> parietal cells –> ATPase H+ secretion

338
Q

Grading of splenic injury

A

1- <1 cm,2- 1-5 cm,3- > 5cm,4- segment/hilar vessels,5- shatteredReturn to activity → injury grade + 2; so grade 2 would be 4 weeks

339
Q

Tx of Zenkers

A

<2cm: circopharyngeal myotomy2-5 cm: myotomy +/- diverticulectomy>5cm: myotomy + diverticulectomy

340
Q

Liver collection txPyo-Amoebic-Echino-

A

Pyogenic- drain and abxAmoebic- metronidazoleEchinococcal- albendazole and resect

341
Q

AT3 def

A

ADnon-vit K dependent protease for 10a potentiated by heparintx- FFP

342
Q

Fibrolamellar HCC

A

well circumscribed w/ central scar similar to FNHnormal AFP and elevated neurotensin (Vs. FNH)

343
Q

Warfarin

A

competitive inhibitor of epoxide reductase (vit K activator)

344
Q

Human bite tx

A

amox/clavulanate (augmentin)MC for human bites- eikenella

345
Q

Variceal bleeding after distal pancreatectomy

A

Gastric varices

346
Q

NNT

A

1/ARRARR = risk w/ tx - risk w/ placebo

347
Q

Surveilance schedule for FAP, HNPCC

A

FAP- start at 10HNPCC- start at 20

348
Q

preA vs. Albumin

A

Prealbumin: t1/2 is 1-2 days; best marker for short-term nutritional statusAlbumin: t1/2 is 21 days; biomarker of long term nutrition; pre op assessment

349
Q

Cause of:gravesTMNHashimoto’sDeQuervains

A

graves- IgG against TSHrTMN- hyperplasia 2/2 low grade TSH stimulationHashimoto’s- antiTG abs (cell-med and humoral)DeQuervains- viral URI

350
Q

Mechanical valve periop

A

restart coumadin in 12-24h and bridge w/ heparin or lovenox

351
Q

Vitamin D processing

A

7-DHC + sunlight –> d3liver –> 25-d3kindey –> 1,25-d3

352
Q

Requirements for lung surgery

A
  • FEV1 > 1.5L (lobectomy), > 2L pneumonectomy- pppo FEV1 > 40%- ppo DLCO > 40%- VO2max > 15
353
Q

TRAM flap

A

SUPERIOR epigastric arterycan use ipsi or contra muscle

354
Q

Normal values: CVP, WP, SVR, CI

A

CVP 2-6WP 4-12SVR 700-1500CI 2.5-4

355
Q

Loop diuretics vs. Ca sparing diuretics

A

loop- furosemideCa sparing- thiazides

356
Q

Indications for chemo with breast cancer

A

> 1cmCx positive nodesTriple negativePoor oncotype

357
Q

TLV

A

TLV = RV + ERV + TV + IRVFRC = RV + ERVIC = TV + IRV

358
Q

VIPoma

A

Loc: distalPx: watery DRH, hypoK, achlorhydria, inhibits gastrin

359
Q

Types of rejection

A

hyperacute- preformed IgG against donor; t2HSacute- T and B cell resposne to MHC; t4HSgraft vs. host- graft T-cells attach host; t4HS

360
Q

Neoinitmal hyperplasia

A

proliferation and migration of vascularsmooth muscle cellsprimarily in thetunica intima, resulting in the thickening ofarterial wallsand decreased arteriallumenspace. cause of restonisis after CEA

361
Q

Benign lesions that require excisional bx

A

Atypical DH/LH LCIS/DCIS radial scar papillary lesion any atypia

362
Q

MC nerve injury Br/Bac fistula

A

medial brachial cutaneous n.

363
Q

Pyloric stenosis

A

px-hypochloremic,hypokalemic metabolic alkalosisdx- UStx- pyloromyotomy

364
Q

Treatment of SVT

A

Vagal maneuvers or adenosine

365
Q

Fuel for colonocytes

A

SCFA (acetate, butyrate, propionate)

366
Q

Tx for hyponatermia

A

Acute sxatic: hypertonic salineHypervolemia: hypertonic salineEuvolemic and asxatic: free water restrictionHypovolemic: volume resuscitate w/ LR or NS

367
Q

Zone injuries

A

penetrating: zone 1-3 –> exploreblunt: zone1 –> explore zone 2-3 –> do not explore

368
Q

Wiskott-Aldrich Syndrome

A

X-linkedTCPenia + combined b/t cell def + eczema

369
Q

hot vs cold nodules

A

hot- surgery or iodine ablationcold- FNA

370
Q

TTP

A

path- def in ADAMtS13px- TCP purpura, neuro sx, kidney dz, hemo anemia, fevertx- plasmapheresis → splenectomy if failed

371
Q

Layers of mucosa

A

EpitheliumLamino PropriaMuscularis mucosa

372
Q

What is not suppressed by high dose dexa

A

Adrenal massEctopic mass (small cell cancer)

373
Q

MOA of tacro, cyclosporine, sirolimus, mmf, basiliximab

A

tacro- calcineurin inhibitorcyclosporine- calcineurin inhibitorsirolimus- mTor inhibitormmf- cell cycle inhibitorbasilixamab- il2 inhibitor

374
Q

Enzymes secreted in their active form from pancreas

A

Amylase/LipaseRibonuclease/Deoxyribonuclease

375
Q

Gastrinoma

A

Loc: gastrinoma triangle (CBD, panic neck, 3D)Px: refractory PUD, gastrin > 200 on sec stim test

376
Q

dx of colovag and colovesic fistula

A

colovag: tampon testcolovesic: CT scan

377
Q

SCIP guidelines

A

Ppx abx 1 hour before incision (vanc can be 2hr) DC abx 24h after end time 48h for cardiac surgery Cardiac pt should have glucose should be < 200 on POD1 and 2 Shaving is inappropriate; should clip hair Remove foley on POD1 or 2 Maintain normothermia (=> than 36) Recieve BB 1 day prior to surgery through POD2 VTE prophy within 24h of end time

378
Q

Milrinone

A

PD inhibitorcontractility with vasodilationgreat for pulmonary hypertension

379
Q

HNPCC inheritance - Amsterdam criteria

A

ADDefect in MLH/MSH 3xrelatives 2x generations 1x < 50y

380
Q

Richter’s hernia

A

protrusion and/or strangulation of part of the intestine’s anti-mesenteric border

381
Q

Plasmin

A

degrades fibrin and fibrinogenactivated by urokinase and streptokinase

382
Q

HNPCC screening and treatment

A

scope q1-2y starting at 20-25 Surgery if:CRC or endoscopically unresectable TAC with IRA and surveillance rectum prophylactic hysterectomy and BSO offered at the time of colectomy Other screens: Annualpelvic exam, endometrial bx, TVUS Upper endoscopy with bxofantrum. treatment ofH. pyloriinfection Annual urinalysis Annual skin/neuro exams

383
Q

Melanoma types

A

superficial spreading- MClentigo- sun exposed, best prognodular- worst prog

384
Q

Replaced Rand L hepatic

A

R- SMAL- left gastric

385
Q

RQ of fat, carb, and protein

A

Carb = 1Protein = .8Fat = .7

386
Q

RR vs. OR

A

RR: of those who were exposed how many got the dz/of those who were not exposed how many got the dz- considers total population. good for prospectiveOR: odds of exposure in cases / odds of exposure in controls(a/c)/ (b/d)- good for retrospective

387
Q

Encapsulate organisms

A

Strep pneumo (MC)NeisseriaHaemophilus

388
Q

MMF

A

MOA: cell cycle inhibitor

389
Q

Immunonutrients

A

GlutamineArginineOmega-3 FA

390
Q

Gail model

A

ageage 1st periodage 1st birth1d relativeprevious bxrace

391
Q

When to operate on adrenal mass

A

all functioning tumorsall > 6 cm –> open resection (no lap)if < 6cm with suspicious features (>10HU, slow w/out) –> open resection (no lap)if bilateral –> tx medically w/spironolactone

392
Q

Origins of medullary thyroid cancer

A

4th pharyngeal arch releases NCC which form parafollicular C cells

393
Q

Bile Acids

A

750 cc/day secretedPrimarybileacids- cholic, chenodeoxycholicSecondarybileacids- deoxycholic, lithocholicprimarybileacids produced by the liver thenundergo deconjugation in the gut by bacteria.<br></br>

394
Q

Component separation

A

External oblique fascia

395
Q

VHL

A

up regulation of vegfhyper vascular tumors

396
Q

Felty syndrome

A

rheumatoid arthritis,splenomegaly, granulocytopenia

397
Q

Merkel cell ca

A

rare neuroendocrine tumor of the skinlooks like BCC w/out rolled edgeshighly radiosensitiveTx- surgical excision + SLNBx + XRT

398
Q

<p><span>Aminocaproic acid</span></p>

A

<p><span>Plasmin inhibitor</span></p>

<p><span>Use: DIC, excess tpa</span></p>

399
Q

Secretin vs. CCK

A

Both released by duoS cells –> Secretin- duct cells –> bicarbI cells –> CCK- acinar cells –> enzymes

400
Q

Nutcracker eso

A

high amplitude/long peristalsisnormal LES pressurenormal relaxation

401
Q

Ectopic parathyroids

A

superior parathyroids is the tracheoesophageal groove and retroesophageal region.inferior parathyroids- anterior mediastinum, thymus, thyroid gland<p style="text-align: center;"></p>

402
Q

421 rule for mIVF

A

4 ml/kg/hr for 1st 10 kg+2 for next 10-20+1 for every kg above 20

403
Q

Inidications for non-op managemement of eso perf

A

early diagnosis or delayed diagnosis with contained leak not in the abdomen contained perforation in the mediastinum content of the perf drain back to the esophagus perforation does not involve neoplasm or obstruction of the esophagus absence of sepsis<p style="text-align: center;"></p>

404
Q

Treatment of GB polyp

A

Sxatic –> resectHigh risk or > 6mm –> resectLow risk –> EUS> 18 mm –> open cholecystectomy, partial liver resection, and possible lymph node dissectionGallbladder polyps that are not resected should be followed-up with serial ultrasound examinations

405
Q

Se, Sp

A

Sensitivity = of the people who have the disease how many test positiveSpecific = of the people who don’t have the disease how many test negative

406
Q

z11 trial implications

A

If less than 3 nodes positive on SLN and T1 or T2 disease, BCT is OK

407
Q

Splenic vein thrombosis

A

If variceal bleeding tx with splenectomy

408
Q

Cervical neoplasia

A

CIN1- tx infection, close f/upCIN2- cryo or leepCIN3- cryo or leep

409
Q

McVay repair

A

Hernia repair without meshApproximates TAA to cooper’s ligament

410
Q

GCS motor

A

6- obeys commands5- localized4- w/draws3- flexion (decort)2- extension (decerebrate)1- none

411
Q

Minimum negative margin for BCC

A

4 mm for unaggressive8 mm for aggressive tumors

412
Q

CO2 vs. NO2 for pneumoperitoneum

A

CO2 advantage- doesn’t combust. less expensive.CO2 disadvantage- acidosis, long elimination, sympathomimetic

413
Q

Mattox maneuver

A

“L –> Mattox”move left structures to the rightexposure left sided vasculatreexplore aorta and L renal vein

414
Q

<p><span>Propofol</span></p>

A

Rapid distribution and on/offs/e- hypotension, resp depression, meta acidmetabolism- liver

415
Q

Pancreas drainage procedures

A

Peustow- pancreaticojej (for large duct)Frey- pancreasticojej + core out headBerger- pancreatic head resection (for large head)

416
Q

Recurrent laryngeal nerve

A

motor to larynx excluding circothryoidinjury: hoarsness, airway compromise

417
Q

Cryo used to treat?

A
  1. VWD2. Fibrinogen def3. Hemophilia A
418
Q

Tx for DVT

A

unprovoked: no RF –> 3-6m acoagprovoked: RF –> 3mopen thrombectomy –> last resort forthreatened limb loss secondary to extensive DVT and phlegmasia

419
Q

Contents of FFP and Cryo

A

FFP: all clotting factors; f5 and 8 decrease over timeCryo: VWF, f8, fibrinogen

420
Q

Ureter anatomy

A

Runs under the vas/uterine arteriesRuns over the iliacs

421
Q

Trauma to the pancreas

A

head- main duct: drain w/ staged resection- tail: draintail- main duct: drain- tail: resect w/ splenectomy (unless child)

422
Q

Central venous O2 vs. mixed venous O2

A

Mixed venous: from PACentral venous: from SVC only (estimation of mixed)

423
Q

Exposing the pancreas

A

Head: kocherize Body: incise gastrocolic ligament –> lesser sac Tail: mobilize spleen

424
Q

Cuff size for kids

A

age/4 + 4

425
Q

Crystalloid and colloid for trauma kids

A

Crystalloid: 20cc/kgPRBC: 10cc/kg

426
Q

qSOFA score

A

AMS (<15)RR > 22SBP < 100

427
Q

Nitrogen balance

A

Nitrogen Balance =Protein intake (grams)/6.25 - (UUN + 4 grams)UUN =grams of nitrogen excreted in the urine over a 24 hour period4 = stool and insensible losses

428
Q

s/e of carb, protein, and lipid

A

carb- immunosuppression, resp failurelipid- pro inflammatoryprotein- false neurotransmitters, rise in ammonia/urea

429
Q

Serum osm calculation

A

2xNa + Glu/18 + BUN/2.8

430
Q

Corrected Ca

A

For every 1 drop in albumin below 4, serum Ca drops by .8

431
Q

Acid/Base of Ng suctioning

A

HypoCl, HypoK metabolic alkLoose HCl and fluidTurn on RAA systemRetain Na/Excrete acid (paradoxic acidurea)

432
Q

Acetazolamide

A

MOA: Ca inhibitorCauses kidneys to excrete bicarb causing a metabolic acidosis

433
Q

Ileal conduit

A

Hyperchloremic metabolic acidosis(urine high in Cl is exchanged for bicarb which is excreted)

434
Q

MC ST sarcoma and dx and tx

A

MC- malignant fibrous histiosarcoma then liposarcomadx- core needle then –> <4cm: excisional >4cm: long. incisionaltx- resection. post op xrt if > 5cm. pre op if > 10cm. doxorubicin.

435
Q

Penecillins evolution

A

Penicillin: strep Methicillin, Oxacillin, Nafcillin: staph Ampicillin, Amoxacillin: enteroccocus Unasyn/Augmentin: GNRs (not psuedo) Ticarcilin/Piperazillin: pseudomonas

436
Q

peri-op anti-PLT therapy in pt with stent/PCI

A

No CVdz: stop ASA 7-10 days before surgery. Restart after 24-72h depending on bleeding in surgery Known CV dz Elective surgery: delay surgery until after optimal time Emergent surgert: c/w DAPT unless high bleeding risk Dual antiplatelet therapy duration:post-pone elective operations two weeks after simple dilatation six weeks after bare-metal stents 12 months after drug-eluting stent

437
Q

Acute cholangitis

A

Dx: U/S showing dilation > 7mm w/ jaundice, fever, RUQ painTx: Mild and responding to abx: ERCP w/in 72h Severe and non responding: ERCP w/in 24h

438
Q

Relative c/i to componenet separation

A

Extensive destruction of the components of the abdominal wall Compromise of the superior epigastric arteryand/ordeep inferior epigastric artery, Contaminated operative field Smoking, COPD, DM, ascites

439
Q

Stimulates pancreas from the jejunum

A

CCKSecreteinGIP

440
Q

MYH gene

A

MYH associated polyposisAR!

441
Q

Cryoptococcus vs. Coccidiomycosis

A

Crypto- CNS sxs in AIDs pt; tx- amphotericinCoccidio- pulm sxs in the southwest; tx-amphotericin

442
Q

hypokalemia on EKG

A

ST depression.T wave inversionProminent U wavesLong QU interval

443
Q

Rectal cancer work-up

A

complete scope: look for synch lesion CT CAP: mets T staging: rectal US (early stage), MRI (late stage)

444
Q

REY GB with choledocho

A

Trans-gastric ERCPor double balloon endoscopy

445
Q

dx of ischemic colitis

A

endoscopy (although CT should be your first test)

446
Q

SIADH tx

A

acute- vaptanschronic- h2o restriction, diuresis

447
Q

Breast abscess that fails to resolve after 2 weeks

A

Excisional bx to rule out inflammatory cancer

448
Q

Sarcoma prognosis by grade

A

1-

449
Q

Tx for ectopic pregnancy

A

Stable– methotrexate or salpingotomyUnstable– salpingectomy

450
Q

Tx ARDS

A

TV at 4-6 ml/kgPermissive hypercapniaP/E < 200 –> high PEEPP/E < 300 –> prone, nm blockade,

451
Q

Pitfalls of hiatal hernia repair

A

Left gastric artery along right crus Abberant left hepatic artery in the gastrohepatic ligament vagus nerve

452
Q

MEN genes

A

1- MENIN2- RET

453
Q

Dx of:Insulinoma:Gastrinoma:Glucagonoma:VIPoma:Somatostatinoma:

A

Dx of:Insulinoma:insulin to glucose ratio > 0.4 after fasting;↑C peptide and proinsulinGastrinoma: serum gastrin > 1000 or SS testGlucagonoma: gasting glucagon levelVIPoma: high VIP and dx of exclusionSomatostatinoma: fastin somatostatin level

454
Q

Incidentally found Meckel’s

A

Child and young adult- resection of the normal-appearing Meckel’s diverticulum healthy, young adults (<50 years of age)-resection of the normal-appearing Meckel’s diverticulum if there is a palpable abnormality orlonger than 2 cm >50 years of age, and patients with significant comorbidities- notresecting

455
Q

Chemo drh

A

loperamide –> octreotideconsider c. diff testing if copious or resistant

456
Q

Choledochol cyst epidemiology

A

females and asians15% get cholagioncarcinoma

457
Q

Tx of desmoid tumors

A

Women, benign but locally invasive;↑recurrencesGardner’s syndromePainless massTx: wide local excision if possible; if involving significant small bowel mesentery, excision may not be indicated→often not completely resectableMedical Tx:sulindacandtamoxifen

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