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Absite 2018 > FIsher > Flashcards

FIsher Flashcards

1
Q

DPL criteria

A 
>10cc blood
>100,000 pRBC
food particles
bile
bacteria
WBC >500
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2
Q

Lefort fractures

A

I- maxillary
II- lateral to nasal bone, under eyes
III- lateral orbital walls

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3
Q 
UE fractures - associated n/a injury
ant shoulder dislocation-
post shoulder dislocation- 
proximal humerus fx
midshaft humerus fx
supracondylar humerus fx
elbow dislocation
distal radius fx
A 
ant shoulder - axillary n
post shoulder- axillary a
prox humerus fx- axillary n
midshaft humerus fx- radial n
supracondylar humerus- brachial a
elbow dislocation- brachial a
distal radius fx- median n
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4
Q 
LE fractures- associated n/a injury
ant hip dislocation
post hip dislocation
supracondylar femur fx
posterior knee dislocation
fibula neck fx
A 
ant hip dislocation- femoral a
post hip dislocation- sciatic n
supracondylar femur fx- popliteal a
posterior knee dislocation- popliteal a
fibular neck fx- common perineal n
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5
Q

RAAS system

A

renin (from kidney)
convertns angiotensinogen (from liver) –> angiotensin I
ACE (from lung) converts AT I –> AT II
angiotensin II –> aldosterone release from adrenal cortex

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6
Q

acid vs alkalotic burns

A

acid- coagulation necrosis

alkali- liquefaction necrosis

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7
Q

nutrition needs in burns

A

25 cal/kg/day + (30cal x %burn)

protein 1g/kg/day + (3g x %burn)

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8
Q

steps in graft take

A

imbibation 0-3d

neovascularization after 3 d

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9
Q

side effects
silvadene
silver nitrate
sulfamylon (mafenide)

A

silvadene- neutropenia, thrombocytopenia
silver nitrate- hyponatremia, hypochloremia
sulfamylon- metabolic acidosis

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10
Q

azygous v and thoracic duct course

A

azygous- right (behind IVC), dumps into SVC

thoracic duct- right side, crosses midline T4/T5, dumps into left subclavian (near IJ)

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11
Q

lung resection PFTs

A

FEV1 >0.8 postresection (if borderline, consider V/Q scan to see which part of lung is shitty)
DLCO >10 postresection
(or >40% predicted postop value)
or preop pCO2>50, pO2<60

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12
Q

lung cancer stage and management

A

obtain bx, staging PET/CT, if stage I or II –> surgery; if + spread –> mediastinal eval (mediastinoscopy v EBUS)

Stage I and II - resection (node negative)
Stage III (node +) - chemo and resection vs definitive chemo/XRT

(+ nodes –> at least stage III)
T3 (still can be resectable, stage II)- invades chest wall, pericardium, diaphragm, <2cm from carina
T4 (unresectable) - invasion to mediastinum, esophagus, trachea, vertebra, heart, great vessels

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13
Q

mediastinal tumors (by location)

A

Anterior- thymoma, thyroid CA, t cell lymphoma, teratoma (other germ cell tumors), parathyroid adenomas
Middle (heart trach aorta) - bronchiogenic cysts, pericardial cysts, enteric cysts, lymphoma
Posterior (esophagus, desc aorta)- enteric cysts, neurogenic tumors, lymphoma

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14
Q

risk factor for tracheo-innominate fistula? tx?

A

trach below 3rd tracheal ring

hold pressure, median sternotomy, ligate innominate

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15
Q

sensory skin nerve cells- pacinian, ruffini, krause, meissner

A

pacinian- pressure
ruffini- warmth
krause- cold
meissner- tactile

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16
Q

TRAM flap- main vessels

A

superior epigastrics

periumbilical perforators important determinant of viablity

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17
Q

pressure sore grading

A

I erythema
II partial skin loss- keep pressure off
III full thickness skin loss- debridement
IV involves bone or muscle- myocutaneous flaps

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18
Q

when to stage melanoma

A

> 1mm depth (panscan)

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19
Q

head and neck melanoma considerations

A

superficial parotidectomy if >1mm for anterior H&N melanoma

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20
Q

peripheral palisading nuclei
stromal retraction
(skin)

A

basal cell carcinoma

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21
Q

most aggressive type of basal cell carcinoma

A

morpheaform type

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22
Q

margins for basal cell and squamous cell carcinoma

A

basal cell- 3-4mm

squamous cell 5-10mm

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23
Q

sarcoma management

A

WLE (1cm), try to get one uninvolved fascial plane

XRT postop, consider preop if really large

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24
Q

risk factors for angiosarcoma

A

PVC and arsenic

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25
Q

merkel cell carcinoma management

A

WLE + SLN biopsy

>2cm (stage II) - get adjuvant radiation

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26
Q

bowens disease

A

squamous cell carcinoma in situ
associated with HPV
imiquimod and ablation
avoid WLE if possible

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27
Q

dermoid cyst management

A

resect d/t malignancy risk

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28
Q

Frey syndrome

A

auriculotemporal nerve injury after parotidectomy

gustatotry sweating

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29
Q

thyrocervical trunk

A 
STAT
suprascapular
transverse cervical 
ascending cervical
inferior thyroid
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30
Q

trap and pec major flaps- artery?

A

trap- transverse cervical a

pec major- thoracoacromial or IMA

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31
Q

modified radical neck dissection vs radical

A

MRND- omohyoid, submandibular gland, C2-C5, facial n cervical br, ipsi thyroid
radical- also take CN XI, SCM, IJ

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32
Q

MC oral cancer location

A

lower lip

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33
Q

oral cavity cancer management

A

WLE

MRND + radiation if >4cm, clinical nodes, or bony invasion

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34
Q

pharyngeal cancer management

A
  • XRT only if <4cm
  • combine sx, xrt for >4cm or bony/nodal invasion
  • angiofibroma, embolize b/f resection
  • nasopharyngeal XRT only
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35
Q

salivary cancer management

A

resection
MRND
postop XRT

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36
Q

CSF rhinorrhea indicator

A

tau protein

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37
Q

peritonsillar vs retropharyngeal vs parapharyngeal abscess

A

peritonsillar- >10yo
retropharyngeal- <10yo ; airway emergency
parapharyngeal (dental infection)- mediastinal spread concern, lateral neck drainage

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38
Q

cleft lip vs palate timing of repair

A

lip- 10wks, 10lbs, hgb 10

palate- 12mo

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39
Q

medical management for pituitary tumors

A 
dopamine agonists (bromocriptine or cabergoline)
consider before transphenoidal resection
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40
Q

nelsons syndrome

A

hypertrophy of pituitary after bilateral adrenalectomy
amenorrhea, visual problems, hyperpigmentation (MSH)
Tx steroids

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41
Q

adrenal vasculature

A

superior adrenal a (inferior phrenic)
middle adrenal a (aorta)
inferior adrenal a (renal a)

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42
Q

incidentaloma workup

A

urine metanephrines/VMA/catecholamines
urine hydroxycorticosteroids
K, renin, aldosterone

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43
Q

management of incidentaloma

A

resect if >4cm, >10HF units, slow washout <50%

biopsy if hx of cancer (lung MC, breast, melanoma)

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44
Q

primary hyperaldosteronism (conn syndrome)- dx and management

A

salt load suppression test (wont suppress)
Renin:aldosterone >20
adrenalectomy
if hyperplasia, consider med management (spironolactone, CCB, potassium replacement); if bilateral adrenalectomy will need lifelong steroid replacement

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45
Q

adrenal insufficiency test

A 
cosynotropin test
(in acute setting give dex before doing this test)
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46
Q

adrenocortical carcinoma management

A

open adrenelectomy, debulking

mitotane

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47
Q

pheochromocytoma rule of 10%

A 
malignant
bilateral
children
familial
extraadrenal (organ of zuckerkandle, RP)
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48
Q

diagnosis of pheochromocytoma

A

VMA, urine metanephrines
MIBG scan
clonidine suppression test (does not suppress)

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49
Q

management of pheo

A

alpha before beta
adrenalectomy (ligate vein first)
metyrosine (inhibits tyrosine hydroxylase)

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50
Q

ima artery

A

occurs in 1%

from innominate or aorta –> thyroid

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51
Q

nerves in thyroidectomy

A

superior laryngeal nerve - circothyroid only, runs superior and lateral to thyroid; loss of projection, easy fatigue
recurrent laryngeal nerve- all other layrngeal mm, in tracheoesophageal groove, hoarseness, airway obstruction if bilateral injury

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52
Q

tubercle of zuckerkandl

A

lateral portion of thyroid
recurrent laryngeal n will be behind this
tubercle is left if subtotal thyroidectomy (ti keep RLN safe)

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53
Q

wolff chaikoff effect

A

thyroid suppression with iodine loading

useful thyroid storm

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54
Q

PTU and methimazole side effects

A

PTU - aplastic anemia, agranulocytosis
MMA- cretinism in preggo, same as PTU
also dont give radioactive iodine to preggo

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55
Q

thyroid cancers

A

PTC- MC, psammoma body, orphan annie nuclei
Follicular- hematogenous spread (usu to bone)
MTC- parafollicular c cells (calcitonin), amyloid deposition
ATC-

MRND for nodal dz or local dz
XRT for unresectable dz

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56
Q

indications for surgery in primary hyperparathyroidism

A

symptomatic

Ca>13, decreased creatinine clearance, kidney stones, low bone mass

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57
Q

tertiary hyperparathyroidism

A

persistent hyperPTH after renal transplant

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58
Q

MEN syndrome genetics

A

Auto dom
MEN I - MENIN gene
MEN IIa, IIb - ret proto oncogene

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59
Q

MEN I

A 
parathyroid hyperplasia (usu first sign)
pancreatic (usu gastrinoma)
pituitary adenoma (usu prolactinoma)
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60
Q

MEN IIa

A

parathyroid hyperplasia
medullary CA- most will have, diarrhea, ppx thyroidectomy at 6yo
pheo

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61
Q

MEN IIb

A

pheo
medullary Ca- most will have, diarrhea, ppx thyroidectomy at 2yo
mucosal neuromas
marfans

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62
Q

LCIS management options

A

observation
tamoxifen ppx
bilateral ppx mastectomy

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63
Q

BRCA I vs II

A

I 60% breast, 40% ovarian

II 60% breast, 10% ovarian, 10% male breast, 10% pancreatic

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64
Q

inflammatory breast cancer management

A

neoadjuvant chemo –> MRM –> adjuvant chemoXRT

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65
Q

contraindications for breast conserving therapy

A

2+ tumors
pregnancy
prior radiation to breast

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66
Q

pagets disease of breast management

A

mastectomy or BCT + radiation

SLN biopsy

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67
Q

stewart treves syndrome

A

upper inner arm
lymphangiosarcoma from chronic lymphedema (after axillary dissection)
usu 5-10 yrs after surgery

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68
Q

type I vs II pneumocytes

A

I gas exchange

II surfactant production

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69
Q

MC lung cancer met?

A

to brain

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70
Q

horners syndrome

A

pancoast tumor

ptosis, miosis, anhidrosis

71
Q

mediastinal GCT management

A

teratoma- resection
seminoma (beta HCG some, no AFP)- XRT
nonseminoma (most will have beta HCG and AFP)- chemo

72
Q

management of pericardial vs bronchiogenic cysts

A

resect bronchiogenic

leave pericardial cysts

73
Q

lung abscess management

A

abx usu will resolve

drain only if unsuccessful

74
Q

left vs right chylothorax

A

injury above T5/6 = left

injury below T5/6 = right

75
Q

chest wall tumors MC (benign and malignant)

A

benign- osteochondroma

malignant- chondrosarcoma

76
Q

ductus arteriosus and ductus venosum

A

areriosus- desc aorta to left PA (shunts away from lungs)

venosum- portal vein to IVC (shunts away from liver)

77
Q

Tetralogy of fallot

A

VSD, pulmonic stenosis, overriding aorta, RVH

78
Q

indications for CABG

A

left main >50%

>70% in other vessels

79
Q

indications for Aortic valve repair

A

peak gradient >50
valve area <1cm2
or symptomatic

80
Q

endocarditis valves involved, bugs involved

A 
aortic valve- prosthetic
mitral- native
tricuspid- drug abusers
staph MC, pseudomonas in drug abusers 
(abx first, surgery if fails)
81
Q

MC cardiac tumors- benign, malignant, met

A

myxoma
angiosarcoma
lugn CA

82
Q

SVC syndrome management

A

usu lung CA mets

emergent XRT

83
Q

CEA nerve injuries

A

vagus n (MC from vascular clamp)- hoarseness
hypoglossal
glossopharyngeal (rare, if high dissection)
ansa cervicalis (no deficits)
facial n mandibular br

84
Q

aortic dissection into which layer?

A

medial layer

85
Q

AAA d/t degen of which layer?

A

medial layer

86
Q

where does AAA rupture most commonly?

A

left posterolateral wall, 2-4cm below renals

87
Q

Complications after AAA repair

A

impotence
MI (MC acute death reason)
kidney failure (MC chronic death reason)

88
Q

AAA endovascular repair criteria

A 
neck length >15mm
neck diameter 2-3cm
neck angle <60
common iliac length >1cm
common iliac diameter 8-18mm
89
Q

endoleak types

A 
I at attachment sites
II collaterals
III overlap sites
IV porosity 
V aneurysm expansion without leak
90
Q

common infections in aortic aneurysms

A

graft infection- staph #1, e coli #2
mycotic aneurysm - salmonella #1, staph #2 (bacteria invades plaque)
(management same, bypass and resect)

91
Q

aortoenteric fistula- presentation and location

A

hematemesis herald bleed, blood per rectum

erosion to 3/4 duodenum at proximal suture line

92
Q

compartment syndrome mediated by which cell type; also which compartment usually?

A

PMNs

anterior compartment

93
Q

popliteal entrapment syndrome

A

claudication with plantar flexion (loses pulses)

resect gastroc muscle

94
Q

most common site of embolic disease

A

common femoral a

95
Q

arterial emboli vs thrombosis management

A

emboli- embolectomy

thrombi- heparin and thrombectomy if limb threatened, otherwise angio and thrombolytics

96
Q

subclavian steal syndrome

A

subclavian artery stenosis –> reversed flow through vertebral artery
angio w stent; common carotid to subclav artery bypass if stent fails

97
Q

median arcuate ligament syndrome

A

median arcuate compresses celiac artery

transect liagment

98
Q

aneurysm complciations

A

rupture (above inguinal ligament)

thrombosis/emboli (below inguinal ligament)

99
Q

when to repair splanchnic artery aneurysms, how

A

> 2cm
except splenic (MC)- symptomatic or childbearing age or >3-4cm
covered stent

100
Q

renal artery, iliac artery, femoral artery, popliteal- when to treat

A 
renal 1.5cm
iliac 3
femora 2.5
popliteal (MC) 2cm 
(all repair with covered stent, except popliteal (bypass!)
101
Q

pseudoaneurysms- management

A

if from percutaneous interventions- compression w thrombin injection, if fails, surgical repair
if at suture line after surgery –> surgical repair
if later complication after surgery, probably graft infection

102
Q

dialysis graft failure MC reason

A

venous obstruction 2/2 intimal hyperplasia

103
Q

migratory thrombophlebitis sign?

A

pancreatic cancer

104
Q

which side more common DVT

A

left more common

105
Q

MC lymphedema bug

A

strep

106
Q

lymphocele management

A

first try perc drainage
resection if fails
isosulfan blue dye to foot to ID channels

107
Q

gastrin, somatostatin, CCK, secretin

A

gastrin (g cells, antrum) –> increase HCl
somatostatin (D cells, antrum) –> inhibits
CCK (I cells, duo) –> GB contract, panc enzyme secretion
Secretin (S cells, duo)–> panc bicarb secretion

108
Q

pancreatic polypeptide action

A

islet cells of pancreas

decrease panc and GB secretions

109
Q

peptide YY

A 
term ileum
inhibs gastric acid secretion
GB contraction 
gastric contraction
panc secretions
110
Q

bowel turnover - stomach, SB, colon

A

stomach 48hrs
SB 24 hours
colon 3-5days

111
Q

esophagus vascular supply

A

mostly directly off aorta
cervical- inferior thyroid a
abdominal- left gastric
venous- azygous and hemiazygous

112
Q

MC location of esophageal perf

A

at cricopharyngeus

113
Q

distance from incisors- UES and LES

A

15cm 40cm

114
Q

surg approach to esophagus

A

cervical left
upper 2/3 right (to avoid aorta)
lower 1/3 left

115
Q

traction diverticulum etiology and management

A

true diverticulum
usu lateral, mid esophagus
inflammation, granulomatous dz, cancer
excision and closure if symptomatic

116
Q

manometry- achalasia, DES, nutcracker

A

achalasia- increased LES pressure, incomplete LES relaxation, no peristalsis
DES- strong, nonperistaltic contractions, normal LES
Nutcracker- high amplitude peristalsis, normal LES

117
Q

achalasia, DES, nutcracker management

A

achalasia- balloon dilation first + CCB/nitrates; consider heller (lower esophagus only)
DES and nutcracker- CCB/nitrates, consider heller (lower and mid esophagus)

118
Q

achalasia causes

A

usu neuronal degeneration

T cruzi can cause similar syndrome

119
Q

esophageal cancer staging and management

A 
TNM + grade, similar to colon cancer TNM
stage I (T1 or low grade T2) - esophagectomy only
stage II (high grade T2 or above) - neoadju chemorads
endomucosal resection for stage IA (low grade T1)
120
Q

esophageal adeno vs squmous cell mets MC

A

adeno- liver

squmous cell- lung

121
Q

blood supply to stomach after esophageectomy

A

right gastroepiploic

122
Q

leiomyoma esophageal- where from and management

A

muscularis propria
no biopsy
excision if >5cm or symptomatic

123
Q

caustic esophageal injury management

A

no NGT, NPO, no vomiting
endoscopy to assess lesion (only do if there is no perf on CT)
primary burn (hyperemia)- conservative management
secondary (ulcers, sloughing)- attempt conservative management
tertiary (deep ulcers, charring) usu will need esopahgectomy

124
Q

esophageal perforation management

A

contained perfs- conservative
<24hrs - consider pirmary repair, consider muscle flaps
>48hrs - if in neck (just place drains), if chest resect or divert…delayed gastric replacement

125
Q

boerhaaves most common perf location

A

usu left lateral wall, 3-5cm above GE junction

higher mortality than other perfs (like iatrogenic)

126
Q

parietal cells

A

release H and IF (binds B12 in term ileum)

stim by Ach (vagus), gastrin (G cells), histamine (mast cells)

127
Q

gastric volvulus management

A

associated with type II hernias

reduction and nissen

128
Q

vagotomy postop problems

A

increased liquid emptying
decreased solid emptying for truncal vagotomy (always do pylorplasty or antrectomy with truncal vagotomY)
diarrhea (due to uncontrolled MMC )

129
Q

anterior vs posterior duodenal ulcer

A

anterior- perforate
posterior- bleed
(anterior MC)

130
Q

management of bleeding duodenal ulcer

A

EGD first

surgery- duodenotomy and GDA ligation

131
Q

gastric ulcer types

A 
(types go from MC to least)
I lesser curve at antrum
II duo and gastric ulcer
III prepyloric
IV lesser curve higher up
V NSAID associated
132
Q

gastric ulcer complication management

A

truncul vagotomy and antrectomy; resect ulcer

133
Q

intestinal vs diffuse gastric cancer management

A

intestinal- subtotal gastrectomy 10cm margins
diffuse - total gastrectomy
no resection if metastatic dz

134
Q

GIST- histo and management

A

ckit postive
malignant if >5cm, >5 mitosis/50HPF
resect w 1cm margins
imatinib

135
Q

RNYGB risks

A

marginal ulcers
B12 definiciency (IF cant bind B12 if not acidic)
IDA (duo bypassed)
gallstones

136
Q

intestinal vs diffuse gastric cancer management

A

intestinal- subtotal gastrectomy 10cm margins
diffuse - total gastrectomy
no resection if metastatic dz

137
Q

hepatic veins drain what

A

left- II, III, IV (sup)
middle- V, IV (inf)
right- VI, VII, VIII
(middle hepatic usu off left hepatic vein)

138
Q

RNYGB risks

A

marginal ulcers
B12 definiciency (IF cant bind B12 if not acidic)
IDA (duo bypassed)
gallstones

139
Q

MC hepatic artery variants?

A

right hepatic - SMA (behind CBD)

left hepatic - left gastric a (in gastrohepatic ligament)

140
Q

hepatic veins drain what

A

left- II, III, IV (sup)
middle- V, IV (inf)
right- VI, VII, VIII

141
Q

coag factors not made in liver

A

vWF and factor VIII (from endothelium

142
Q

crigler najar, dubin johnson

gilberts and rotors

A

crigler najar and gilbert- indirect

dbin johnson and rotors- direct

143
Q

best lab for liver function

A

PT

144
Q

best diuretic for ascites

A

aldactone

aldosterone usu high, d/t poor hepatic cleranace

145
Q

Spont bacterial peritonitis features

A

PMN >250

usu e coli (mono organism MC)

146
Q

esophageal varices med management

A

vasopressin (constricts)
octreotide
propranolol (prevents rebleed)

147
Q

childs pugh score and mortality risk

A

A 2%
B 10%
C 50%

148
Q

liver abscesses

A

amebic- entamoeba, tx w flagyl
echinococcus- ectocyst (calcification), endocyst (double walled), dont’ aspirate!, albendazole and resect
pyogenic

149
Q

kasabach merritt syndrome

A

coagulopathy and CHF 2/2 liver hemangioma

150
Q

HCC margins

A

1cm

151
Q

Meds to contract, relax sphincter of oddi

A

morphine contrascts

glucagon relaxes

152
Q

hormone from duo and stomach

A

gastrin (g cells, antrum) –> increase HCl
somatostatin (D cells, antrum) –> inhibits
CCK (I cells, duo) –> GB contract, panc enzyme secretion
Secretin (S cells, duo)–> panc bicarb secretion

153
Q

CCK HIDA indications for cholecystectomy

A

no gallbladder filling
EF <40%
>60min to empty (chronic cholecystitis)

154
Q

bile duct stricture causess

A

lap chole (ischemia)
chronic pancreatitis
cancer (until proven otherwise if non above)

155
Q

hemobilia-

A 
fistula bile duct and hepatic artery 
UGI bleed, jaundice, RUQ pain 
usu d/t trauma and iatrogenic
angiogram dx
angioembo tx
156
Q

gallbladder cancer resection

A

gallbladder only if not into muscle
wedge resection if to muscle of 4b and 5
formal resection if past

157
Q

bile duct cancer risk factors

A

c sinesis, UC, choledochal cysts, PSC, CBD infections

158
Q

choledochal cyst types

A 
I- fusiform
II- diverticulum
III intraduodneal
IV- intra and extrahepatic
V caroli
159
Q

endocrine pancreatic cells

A 
alpha- glucagon
beta- insulin
delta- somatostatin
F- pancreatic polypeptide
Islet- VIP
160
Q

Pancreatic divisum ERCP findings

A 
minor papilla (santorini) will be big
major papilla with be short (wirsung)
161
Q

pancreas “chain of lakes”

A

chronic pancreaatitis

162
Q

chronic pancreatitis surgical management

A

puestow- pancreaticojejunostomy (if large duct)
beger- head resection
frey- core out pancreas, pancreaticoJ

163
Q

pancreatic endocrine tumors- malignant vs benign

A 
nonfunctional- usu malignant
insulinoma- usu benign
gastrinoma 1/2 1/2
glucagonoma- usu malignant
somatostatinoma- usu malig
VIPoma- usu malig
164
Q

management of NEC panc tumors

A

<2cm enucleat
>2cm formal resection
5FU and streptozocin

165
Q

gastrinoma triangle

A

CBD, pancreas neck, D3

166
Q

imaging for gastrinoma

A

octreotide scan

167
Q

ITP vs TTP treatment

A

ITP - steroids and IVIG; try to avoid splenectomy before 10yo
TTP- plasmapheresis (usu wont require spelenctomy)

168
Q

feltys syndrome

A

RA, hepatomegaly, splenomegatly

169
Q

dentate line- differentiates

A 
2cm from anal verge
divids upper 2/3 from lower third
columnar vs stratified squamous 
superior rectal vs mid/inf rectal v
internal vs ext hemorrhoids
170
Q

Crohns features

A 
spares rectum
transmural involvement
skip lesions
cobblestoning
creeping fat
fistulas
171
Q

small intestine carcinoid

A

5HT, bradykinin
octreotide scan to localize
chromagranin A
enterochromaffin cells

172
Q

dentate line- differentiates

A 
2cm from anal verge
internal iliac v superior inguinal LN
columnar vs stratified squamous 
superior rectal vs mid/inf rectal v
internal vs ext hemorrhoids
173
Q

rectum arteries and veins

A

superior rectal –> IMA
middle rectal –> interal iliac
inferior rectal –> interal pudendal (int iliac)

sup/mid rectal

174
Q

colon main nutrient

A

Short chain FA

Absite 2018 (2 decks)

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