Final Written Exam Flashcards
1
Q
Prostate cancer surgery best anticoagulant
A
subQ LMW heparin
2
Q
enlarging mass in breast of pregnant woman first step
A
excisional bx
3
Q
MELD score components (3)
A
bic
Billi
INR
Creatinine
4
Q
Murmur likely to increase risk of operative complications
A
S3 gallop
5
Q
Perioperative insulin regimen
A
1/2 usual dose long actin AM of surgery
6
Q
Anesthetic that produces life threatening hyperkalemia
A
succinylcholine
7
Q
Who gets pre-op ECG
A
older male being evaluated for CEA
8
Q
Hypocalcemia symptom
A
carpopedal spasm
9
Q
How to replace fluid lost from fistula
A
lactated ringers
10
Q
Bile composition ~
A
Na 130
K 4.0
Cl 100
Bicarb 25
11
Q
Large bilious drainage from drain at gastrojejunostomy site likely =
A
leak from duodenal stump
12
Q
Pyloric stenosis metabolic derangement
A
hypochloremic hypokalemic metabolic alkalosis
13
Q
TPN for anorexia –> proximal muscle and visual deficits =
A
hypophosphatemia
14
Q
SIADH management
A
water restriction to less than 1000ml/day
15
Q
Hyponatremia + hyperglycemia management
A
hyponatremia not initially management because high glucose creates dilutional effects
16
Q
4 days of N/V most important labs
A
electrolytes
17
Q
Perforated duodenal ulcer = high risk of
A
nutritional deficiency because all shit is absorbed there
18
Q
Where in the GI tract is iron absorbed?
A
jejunum
19
Q
Which lab reflects protein anabolism
A
pre-albumin
20
Q
Most oral meds are absorbed ____
A
in duodenum
21
Q
Two signs of refeeding syndrome
A
anemia + respiratory distress
22
Q
which macronutrient groups have lowest/ highest kilocals
A
lipids high –> proteins –> carbs low
23
Q
Major cause of cachexia in short bowel syndrome
A
malabsorption
24
Q
Clue to diarrhea 2/2 tube feedings
A
high osmolarity feedings
25
Parenteral nutrition can be stopped when enteral caloric intake reaches _____
66% of PN
26
KCal need/ lb
9.6 kcal/lb
27
Cause of bleeding in patient receiving abx
vitamin K deficiency
28
Greatest infectious risk assc with transfusion
Hep B
29
Best treatment for bleeding in von Willenbrand disease
cryoprecipitate
| VIII, vWF, XIII
30
OTC supplement that causes increased bleeding
garlic
31
Bleeding + severe muscle cramps EKG changes
Prolonged QT interval 2/2 ST segment elongation
32
Cause of clotting in protein C mutation
factor V neutralization impaired
33
How to assess bleeding in LMWH patients
anti-Xa activity
34
Cause of bleeding in recovery room
inadequate surgical hemostasis in operation
35
Massive trauma how to maximize blood transfusion
red cells: FFP: platelets 1:1:1
36
lactic acid measurement is a marker of
response to circulatory resuscitation
37
Cause of hypotension in severe pancreatitis
poor venous return
38
Pancreatitis best resuscitation
3L isotonic crystalloid
39
Severe gallstone induced pancreatitis/ pulse 120- hemodynamic state
hyperdynamic perfusion
40
Hemorrhage following MVC --> principal cause of hypotension
venous return
41
Perforated diverticulitis --> hemodynamic state
hypovolemic hypoperfusion
42
Shock w/ gallop + distented neck veins --> cause
decreased cardiac contractility
43
Cause of increased hgb in respiratory failure
interstitial fluid accumulation
44
Hyperglycemia increases risk of
infectious complications
45
What helps prevent ventilator assc PNA
elevate head of bed
46
Hemorrhagic shock reason for urgent dialysis
hyperkalemia
47
most common cause of death in acetaminophen OD
cerebral edema
48
Alternative treatment in case of HIIT
switch to argatroban
49
respiratory failure ventilator mode that assumes most work of breathing
assist control ventilation
50
ARF what improves oxygenation
high PEEP
51
Pt who takes steroids develops interoperative hypoTN best step
administer hydrocortisone
52
Mechanism of poor wound healing with Zn deficiency
decreased fibroblast proliferation, collagen synthesis/ overally wound strength
53
How to reduce bacterial load in decubitus
debride
54
Nodule at incision site likely =
suture granuloma
55
wound two weeks out is mostly made of
collagen, scare inflammatory cells
56
Phases of wound healing
1st week is inflammatory with PMNs --> macs
1 weeks- month: proliferative (collagen)
2 maturation/ remodeling
57
Thickening and overturning of wound edge requires
wound edge biopsy
58
What should be supplemented before surgery in person with limited diet
vitamin C
59
Safest amount of lidocaine 1% 60kg
0.5 ml/kg
| so 30 mL
60
Typical post op abx in uncomplicated surgery
none neeed
61
Scars that extend beyond the confines of original incision are
keloids
62
Open AAA repair requires
px abx
63
Initial management C diff
oral vanco
64
When is IV px abx administered
1 hr before sx
65
decreased hearing with abx use suspect what abx
vanco
66
Purulent drainage from old IV site next step in management
excision of IV site
67
What assesses acceptability for organ donation
latent HTLV/ NAT confirms
68
Best management for SBP following tap
IV abx in hospital
69
Subhepatic abscess management
imaged guided perc drainage
70
Most likely source of e coli sepsis
UTI
71
deep rusty puncture wound management
0.5 mL tetanus toxin
72
DIP swelling infection management
excision of the overlying nail plate
73
weakness both arms following trauma dx
central cord syndrome
74
Blunt abdominal trauma + pain + negative FAST + stable --> next step
CT scan
75
Convex collection of blood in head =
epidural hematoma
76
Tensely swollen calf management
operative fasciotomy
77
Acidosis + tensely distended abdomen =
ACS
78
painful stimuli
decorticate posturing
moans
GCS
7
79
Gun shot wound to a kids belly --> diffusely tender next step
ex lap
80
Neck stab 2 cm below mandible next step
emergent neck exploration
81
Parasternal stab wound --> during fast undetectable BP next step
left thoracotomy and cardiac repair
82
Class III hemorrhagic shock urine output
5-15 cc
1 is above 30
2 is 20-30
83
goal of burn rehab
prevent scar contractures and immobility
84
best choice for preventing burn wound sepsis
excision and grafting within 5-7 days of injury
85
Carbonaceous debris in nose and mouth + stridor following burn next step
intubate
86
Appropriate steps in management of severe burns
1. secure airway, get IVs
2. CT scan head and abdomen
3. Calculate TBSA and start condense formula
4. silvadine
87
TBSA answer on this test
45%
88
Which burns are least painful
third degree full thickness
| hands in this question
89
Best pain management for lots of 2nd degree burns
IV narcots --> narcoids --> NSAIDs
90
No pulse in burnt extremity management
lateral and medial escharotomies
91
Allograft=
skin from human cadaver
92
What burn treatment provides best functional/cosmetic outcome
tangential excision and full thickness grafting
93
What is below campers fascia in lateral abdomen
external oblique aponeurosis
94
Scarpas fascia turns into what structure
dartos fascia
95
Sx of an obturator hernia
intermittent bowel obstruction
96
bulge inferior to inguinal ligament =
femoral hernia
97
What is a ricters hernia
non circumferential incarceration of bowel wall
98
name of incision
mcburney
99
What is the weird contraindication answer
total extraperitoneal lap repair
100
Explain abdominal varices
portal vein shunted to paraumbilical veins
101
Bulge in epigastrum from xiphoid to umbilicus is
diastasis recti
102
What causes risk of incisional hernia
wound infection
103
Suicide attempt by drain cleaner next step
intubaton
104
Treatment of zenkers diverticulum
diverticulotomy with cricopharyngeal and lower esophageal myotomy
105
Management of barrets
repeat endo x 6 months and do 4 quad bx
106
Type 2 asx paraesophageal hernia management
observe
107
Treatment of achalasia
combined heller myotomy and nissen fundoplication
108
Treatment of early stage 1 esophageal adenocarcinoma
transhiatal esophagectomy with gastric pull up
109
Treatment of GERD that is not controlled with meds
Collis gastroplasty with nissen
110
Submucosal lesion in mid esophagus management
enucleation of lesion with reapproximation of muscle layer
111
Chest pain after endoscopy location of source
posterior mediastinum
112
Most useful way to stage esophageal adenocarcinoma
endoscopic ultrasound
113
Sibutramine MOA and side effect
SNRI
| HTN
114
What mediates acid release upon smell of fodd
Ach
115
Nonhealing gastric ulcer management should include
diagnostic lap
116
Persistent stage III ulcer with no malignancy treatment
antrectomy with truncal vagotomy
117
What is a contraindication for surgical intervention to assist with weight loss
colon cx history
118
Pool of bile in distal stomach leading to pain best treatment
cholestyramine
119
Treatment of N/V/D after meals following antrectomy
somatostatin
120
Pesistenly elevated Ca treatment
parathyroidectomy
121
Most common nutritional change following Roux En Y
Iron
122
What characterizes small intestinal absorptive function
linked to Na-coupled nutrient absorption
123
Hx of malrotation in kid --> acute symptoms ---> __
midgut volvulus
124
What is the role of the migrating motor complex
prevents stasis and overgrowth
125
Most common metabolic change assc with chrons
B12 deficiency
126
What chrons fistula most likely requires surgical therapy
enterovesical
127
Large amounts of green brown fluid through NG tube treatment
schedule emergent laparotomy
128
FAP most common site of extra colonic malignancy
periampullary duodenum
129
What may cause short bowel syndrome following surgery
preserving less than 60 cm small intestine
130
Meckels test
technetium scan
131
Tumor that is part of APUD system
carcinoid
132
LLQ tenderness + elevated white count next step
CT scan abdomen
133
Best choice for identification of bleeding site is
technetium labeled RBC scan
134
One internal hemorrhoid that reduces spontaneously --> management
increase dietary fiber and re-evaluate in 2-3 months
135
21 year old with RLQ pain and white count next step
appy
136
Distended colon in demented person dx
colonic volvulus
137
Man passes gas through urethra next step
CT
138
Best initial management of sigmoid volvulus:
sigmoidoscopic attempt at reduction
139
Hemorrhoids that require manual reduction - treatment
surgical hemorrhoidectomy
140
Perirectal drainage treatment
proceed to OR --> exam and drain under anesthesia
141
IBD with normal ileum =
UC
142
Cholangitis treatment
resuscitation
IV abx
urgent ERCP
143
Jaundice + high alk phos + high tbili and LFTs
choledocolithiasis
144
Gallbladder disease without jaundice is
cholecysstitis
| cholangitis is jaundiced
145
Large stone in neck of gallbladder most likely diagnosis
Mirizzis syndrome
146
Most common makeup of gallstones
cholesterol
147
Biggest risk factor for development of gallbladder disease
female
148
Next step in cholecystitis after pain control
ERCP with sphincterotomy
149
Can lap chole be done in patients with prior open surgeries
yes
150
Anatomic cause of recurrent pancreatitis
pancreas divisum
151
Most common location for gastrinoma
descending duodenum
152
Tumor of pancreatic head without vessel invasion management
excise tumor
153
Cyst that communicates with main pancreatic duct needs
pancreatic cyst gastrectomy
154
Insulinoma is visible on ____ scan
somatostatin
155
Endocrine complication of chronic pancreatitis
diabetes
156
What arteries are ligated during pancreaticoduodenectomy
inferior anterior pancreaticoduodenal artery and gastroduodenal artery
157
Pancreatic phlegmon with narrowing of duodenum causes
gastric outlet obstruction
158
Where are islets of Langerhans most abundant
tail of pancreas
159
Pancreatic tumor with vascular involvement treatment
whipple
| pancreaticoduodenectomy
160
Hepatic colorectal mets management
surgical resection
161
liver lesion with central scar management
observe only
162
HCC management
liver resection
163
Failed banding of esophageal varices next step
transjugular intrahepatic portacaval shunt
164
Dx of liver mass with thick wall and multiple septations
cystadenoma
| resect
165
Common contraindication to liver transplant
severe pulm disease
166
Liver lac without free fluid in abdomen --> later hematemesis management
IR with selective hepatic artery embolization if bleeding site identified
167
Liver lac without free fluid in abdomen management
closely monitor
168
Asterixis --> best drug
lactulose
169
hepatic adenoma treatment
arterial embolization
170
Treatment of subareolar abscess
antibiotics followed by excision of the subareolar ducts and fistula tract
171
Fibroadenoma management
after bx just observe
172
First step in management of UUQ density in young woman
breast US
173
Contraindication to lumpectomy
pregnancy
174
Breast cancer in skin cells = what stage
3
175
Best way to follow prior breast cx patient
PE q6 mammo annually
176
Posterior aspect of upper arm numbness following breast cx surgery what nerve
intercostal brachial
177
25 year old woman with 2.5 cm hypoechoic mass treatment
aspirate the lesion
178
Adverse effect of whole breast radiation
fibrosis
179
Prior to distal pancreatectomy what lab must be done
calcium
180
follicular thyroid cancer best first step in management
thyroid lobectomy
181
What diuretic causes hypercalcemic
HCTZ
182
Papillary carcinoma of thyroid best step in management
total thyroidectomy
183
Adrenal mass detected during trauma --> next step
repeat adrenal CT scan at later time
184
Graves pathogenesis
IgG that stimulates TSH
185
HSP
observe
186
When to give pneumovax with planned splenectomy?
| emergency splenectomy?
2 weeks prior
| on the day of d/c
187
When to transfuse platelets in splenectomy
after artery is clamped
188
neutropenia + chronic enlarged spleen treatment
splenectomy
189
noncaseating granulomas hilar region cause
sarcoidosis
190
Blood smear findings with spleen infarct
HJ bodies
191
Node in anterior cervical triangle near jaw angle=
carcinoma
192
Why give splenectomy in thal
decrease transfusion needs
193
5.6 cm incidental AAA best management
endovascular repair
| decreased mortality
194
Most appropriate way to assess vascularity before AAA repair
CT angiogram of the pelvis and lower extremities
195
Highest risk factor for AAA
prior history of popliteal aneurysm
196
What is an indication to intervene for her symptomatic right leg?
medical leave from job
197
32 year old woman HTN abdominal bruit cause
FMD
198
What decreases pressure gradient across a stenosis
radius of lesion
199
Type A dissection best management
urgent operative repair
200
Severe bilateral aortoiliac occlusive disease management
bilateral aortobifemoral bypass
201
Woman with venous insufficiency most likely sequelae
ankle ulceration
202
What exam finding is most consistent with PAD
aching foot pain
203
Twin sister organ donation best immunosuppression
none
204
Immunosupressant with HTN/ tremors/ LFTs
tacrolimus
205
1 year survival rate for cardiac transplant (when pt is compliant)
80%
206
What drug is most useful for maintaining BP in brain dead organ donors
dopamine
207
Immunosupressant most likely to cause leukopenia
cellcept mycophenolate
208
How long can liver be kept on ice
18 hours
209
MOA of alemtuzumab
depletes B and T lymphs
210
What is the best criteria for cessation of brain function
absence of spontaneous respirations
211
Which of the following = cellular arm of the immune response
mixed lymphocyte culture
212
Hep C vs wilsons disease liver failure who is higher on transplant list
Wilsons
213
Large heart + pulm vascular congestion --> what transplant?
lung!
| Pulm HTN
214
Immunosupressant that causes glucose intolerance
tacrolimus
215
Obliterative bronchiolitis in lung transplant -->
chronic rejection
216
Organ transplant from sibling with 6 antigen match --> best immunosupressants
combo (cellcept, tacrolimus, prednisone)
217
Stain for GIST
c-kit
218
TNM staging for calf melanoma
T1bN0M0
219
Melanoma excised --> positive what next?
wide local excision of scar
220
Sarcoma in quadriceps best step to dx
incisional bx
221
BRCA1 gene best px
bilateral mastectomy
222
Mohs is used when?
when need to preserve normal tissue
223
Suspicious skin lesion on back - lymphadenopathy best dx
excisional bx w/ 1-2 mm margin
224
1.0 cm suspicious lesion in RUL lung with + PET scan next step
VATS
225
5 cycles chemo --> breast lumpectomy ---> next step
adjuvant chemo
226
PET scan shows + skin lesion on next --> no other lesions --> next step
FNA of neck lesion
