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General Flashcards

1
Q

Bacteria and viruses associated with acalculous cholecystitis?

A

CMV
EBV
Salmonella
Brucellus

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2
Q

Best individual lab for choledocholithiasis?

A

Bili >3

69/88% sen/spec

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3
Q

sizes that matter for CBD stone?

A

<3 very unlikely
>10= 90%

If stone seen with US it is 100% specific. Just bad sensitivity at 18-74

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4
Q

percent of pancreatitis from ERCP?

A

3.5%

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5
Q

Ways to stratify patients with CBD stones?

A

High, moderate or low

based on american society of gastroentestinal endoscopy

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6
Q

Treatment of gallstone panc?

A

ERCP and early cholecystectomy

- labs do NOT need to normalize just patients pain needs to improve

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7
Q

Riglers triad?

A

Pneumobilia
Bowel obstruction
Stone seen on imaging
- dx gallstone ileus

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8
Q

Where is a bravo probe placed?

A

5cm above LES

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9
Q

What is the advantages of impedance monitoring rather than pH probe?

A
  1. Detection of reflux regardless of pH (bile reflux)
  2. Detection of reflug regardless of Solute (food, gas, air, liquid)
  3. Detection of height of reflux
  4. Detection of reflux even if on PPI’s or antireflux meds
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10
Q

Bad demeester score?

A
  1. 97 is 95th percentile

- positional and subjective as well as objective

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11
Q

What chemokine causes cachexia?

A

TNF-a

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12
Q

What lab value is measured to monitor tPA or catheter directed therapy for arterial clot? What levels of this predict bleeding?

A

Fibrinogen

<150 mg/dl

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13
Q

Risk of major and minor bleeding with CDT?

A

8.8% for major

44% for minor

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14
Q

What does acral and lentigo mean?

A

Peripheral body part

freckle or dark spot

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15
Q

Most common melanoma? Most aggressive? least aggressive? MC mets?

A

Superficial spreading
Nodular–> blue lesions, vertical growth first
Lentigo maligna–> radial growth before deep growth
Lungs

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16
Q

difference between modified brooke formula and parklands formula?

A

2cc/hr vs 4cc/hr xTSBA x Weight kg’s

  • leads to less fluid overload. Titrate to 0.5-1cc/hr/kg UOP
  • Both only 2nd and 3rd degree burns
  • need to have >10%, 15%TSBA burned in peds, adults respectively
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17
Q

Zinc deficiency leads to what symptoms?

A

FTT
Impaired wound healing
Skin rash

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18
Q

What soft tissue cancer is associated with Spindle cells and CD-34?

A

Dermatofibrosarcoma

- characteristically laterally extension–> thus high risk for local recurrence

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19
Q

What causes erythema and warmth of breast in inflammatory breast cancer? also known as?

A

Invasion of cancer into dermal lymphatics leading to swelling, erythema and warmth of breast
- Peau d’orange

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20
Q

Treatment for inflammatory breast cancer?

A

Neoadjuntive chemo
Modified radial mastectomy
Rads

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21
Q

Most common site of iatrogenic Esophageal perf? how about boaerhave’s?

A

At level of crycopharyngeus muscle

Left site of distal esophagus

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22
Q

HPV strains associate with warts?

A

6, 11
1= foot warts
2= hand warts

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23
Q

HPV strains associated with Cancer?

A

16,18,31,33,45

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24
Q

Differences between condyloma accuminata and lata?

A

First is from HPV looks like cauliflower

2nd is syphyllis is white and flat

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25
Q

voltage of high voltage electrical injury?

A

> 1000V

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26
Q

What is a Peustow’s procedure and indications?

A

Longitudinal pancreticojejunostomy

  • for dilated pancreatic ducts throughout with inflammatory mass at head
  • Duct needs to be greater than 6-8mm wides for this
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27
Q

What is a Frey procedure?

A

Longitudinal pancreticojejunostomy with pancreatic head core out

  • one loop of jejunum brought up for large PJ
  • for small masses of pancreatic head with main duct dilation
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28
Q

What is a Bern procedure?

A

resection of pancreatic head with Roux-en-y PJ

  • for large pancreatic head masses without main duct dilation
  • dont resect completely to portal vein
  • only one mosis
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29
Q

Beger procedure?

A

Similar to Bern but more aggressive

  • BEGER is longer then BERN and thus more aggressive
  • has two mosis’es
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30
Q

Morgagni hernia location?

A

congenital diaphragmatic hernia located anterior-medially

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31
Q

Bochdeleck hernia?

A

Posterior-lateral hernia of congenital diaphragm

- much more common than Morgagni

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32
Q

Malignant hyperthermia ion involved and pathophys?

A

Calcium

  • sustained release of CA2+ from SR leading to prolonged muscle activation and contraction
  • inhaled halogens
  • Succ and suxamethonium
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33
Q

Medullary thyroid carcinoma is made of which cells? Releases what?

A

Neural crest cells

- releases Calcitonin from C- cells

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34
Q

What is the cause of Lymphoma after an organ transplant?

A

Post transplant lymphoproliferative disorder

  • increases production of B-cells
  • predisposes one to Lymphoma after a organ transplant
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35
Q

What are some purine synthesis inhibitors?

A

Azathiaprine (Imuran)
mycofenolate mofetil (cellcept)
- inhibits iosine monophosphate dehydrogenase and stops production of B cells

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36
Q

What are the pryrmidine inhibitors?

A

Leflunomide
teraflunomide
- for RA and psoriatic arthritis

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37
Q

What does cyclosporine inhibit?

A

INF-gamma

- IL 2, 3, 4

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38
Q

Mechanism of action of steroids?

A

Inhibits cytokine gene transcription of macrophages and decreases release of IL-1,6 and TNF-a
- also inhibits release of cytokines from T-cells which decreases response to B-cells and macrophages

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39
Q

Zenkers diverticuli true to false?

A

False

- means that mucosa and submucosa herniate through muscle wall

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40
Q

Traction diverticuli? MC location in esophagus?

A

From LAD pulling on esophagus

  • true divertculum
  • all the layers
  • mid-esophagus
41
Q

Mechanism of ESRD and hypocalcemia?

A

Kids not as responsive to PTH and thus pee out more Calicum

  • increase PTH leads to more bone breakdown which releases phosphates and calcium
  • Decreased activation of Vitamin D 1,25 type
  • this vitamin helps increased intestinal absorption of Calcium
42
Q

Common side effect of silver nitrate?

A

Low electrolytes

  • specifically hyponatremia
  • Methemoglobinemia
43
Q

Side effects of sulfamulon (mefenide sodium/acetate)

A

Systemically absorbed and thus metabolic acidosis

- inhibits carbonic anhydrase

44
Q

Side effects of silvadene (silver sulfadiazine)?

A

Neutropenia and thrombocytopenia

45
Q

What is phimosis and paraphimosis?

A

inability to retract foreskin past glans of penis
- If this foreskin gets stuck retracted–> constrictions venous and lymphatic outflow with arterial inflow–> significant edema and urological emergency

46
Q

predominant cellular source of TNF-a?

A

Macrophages

47
Q

Treatment for anal melanoma?

A

WLE vs APR

- does not respond to immuno/chemo/rads therapy

48
Q

MOA of tacrolimus? MC side effect?

A

Calcinuerin inhibitor- similar to cyclosporin in inhibiting Cytokines but more potent against IL-2
- Neurotoxic leads to headaches, seizures, tremors and confusion

49
Q

MC side effect of mycophenolate?

A

GI related–> diarrhea

50
Q

MC side effect of azathioprine?

A

Bone marrow suppression

51
Q

MC long term complication of J-pouch after total proctocolectomy for UC?

A

Pouchitis

- up to 50% of patients

52
Q

Pathophys of hepatorenal syndrome?

A

renal artery vasocontriction in setting of splanchnic and systemic vasodialtion

53
Q

MOA of hepatorenal syndrome?

A
  1. Activation of Renin angiotesinogen system from HoTN
  2. increase sympathetics from HoTN and increase intrahepatic sinosidal pressure
  3. increase release of arginine vasopressin
  4. reduced hepatic clearance of vasodilators
54
Q

Who is at greatest risk of post splenectomy sepsis syndrome?

A

Children before age 3. ideally wait until child is about 5

- if taking out spleen for hematological or malignancy

55
Q

Types of le fort fractures?

A

1- Horizontal through maxilla

  1. Pyrymidal involving nasal bone, orbit and maxilla
  2. Complete craniofacial seperation (lateral fracture of orbit)
    - all have pterygoid plate fx involvement
56
Q

Types of internal hernia locations after Roux-en-y?

A

three of them

  1. Petersen’s–> between transverse mesocolon and roux limb mesentery
  2. Opening in transverse mesentery
  3. mesenteric opening at the biliopancreatic limb
57
Q

Which product of blood that is donated cannot transmit viruses?

A

Albumin

58
Q

What are the causes of chloride wasting metabolic alkalosis?

A

Diarrhea
Massive vomiting
chloride riding diuretics

59
Q

What are the causes of chloride resistant alkalosis?

A 
Conn syndrome 
2' hyperparathryoidism
Cushing
Little syndrome
Bartter syndrome
exogenous corticoids
60
Q

What supplies 3 segments of esophagus?

A

Cervical–> inferior thyroid (thyrocervical trunk from subclavian)
Thoracic- aorta
Abdominal- LEFT gastric

61
Q

most common site for colonoscopy perf?

A

Sigmoid-70%

62
Q

Most common instrument left in abdomen?

A

Mallable

63
Q

ovarian tumors assocciated with Lactate dehydrogenase?

A

Dysgerminomas

64
Q

Ovarian tumors associated with CA-125?

A

Epithelial

65
Q

Ovarian tumors associated with B-hcg?

A

Germ cell, Embyronic, chorio

66
Q

Ovrian tumors associated with A-fp?

A

all else

- yolk sac, embryonal, tertatomas, mixed germ, polyembryonal

67
Q

Contraindications to liver transplant?

A

Cant handle surgery- cardiac pulmonary

  • also recent intracranial bleed
  • extrahepatic malig
68
Q

mc quick treatment for anal incontinence from obstetric trauma?

A

Wrap around sphincteroplasty

- mobilizing and identifying the sphincter and reapproximate without tension

69
Q

stage I and II rectal cancer treatment?

A

Surgery followed by chemo/xrt

70
Q

Stage III rectal cancer tx?

A

Neoadjuvant chemo/xrt
surgery
followed by adjuvant chemo

71
Q

Hypomagnesium usually resembles which other low electrolyte and why?

A

Hypocalcium

  • magnesium is needed to release PTH
  • they have similar neuromuscular disturbances
  • eye twitches, irritability, muscle spasms, fatigue
72
Q

most common mutation associated with pancreatic tumors?

A

K-ras- 80-100% if them
p53 only 75%
- the later is a tumor suppressor and the firrst is an oncogene

73
Q

MOA of milronone and amrinone?

A

Phosphodiesterase inhibitors which leads to increase in cAMP which increases CA uptake by SR which causes increase in ionotropic effects of cardiac tissue

also leads to vascular smooth muscle relaxation

74
Q

Myeloproliferative disorders are commonly associated with?

A

Budd-chiari syndrome

- thrombosis of hepatic veins

75
Q

What is efferent loop syndrome?

A

After roux-en-y or billroth type surgeries

  • abdominal pain, bilious vomiting, nausea
  • typically in 1st month
  • kinking of efferent limb typically behind the GJ anastomamosis
  • tx: surgery
76
Q

What is afferent loop syndrome/

A

Typically from it being too long
- acute or chronic
- abdominal pain and vomiting
Tx: shorten loop

77
Q

Primary fuel source when NPO for enterocytes?

A

GLutamine

When not NPO its medium chain fatty acids

78
Q

Primary fuel source for colon cells?

A

Short chain fatty acids

79
Q

Fungal liver abscess mc species?

A
  1. candida
  2. aspergillus
  3. cryptococcus
80
Q

What is Nodular lymphoid hyperplasia?

A

Numerous polyps in rectum, colon and small bowel

  • associated with immocompromised individuals
  • HIV, malignancy, hematoproliferative disorders
  • no surgery needed–> seek cause
81
Q

MC primary cardiac tumor in children?

A

Rhabdomyomas

  • cardiac- watch and wait. take out only if causing outlet obstruction
  • multiple
  • > 50% associated with tuberous sclerosis
  • Not malignant
82
Q

Bilateral mobile rubbery masses in older? male

A

Likely gynecomastia

  • watch and wait
  • happens to neonates, adolescence and older gentlemen
  • US if under 25 or unilateral
83
Q

mneomonic for abnormal uterine bleeding?

A 
PALM-COEIN
Polyp
Adenomyosis
leiomyoma
malig
Coagulopathy
Ovulatory dysfunction 
Endometrial
iatrogenic
84
Q

MC reason for hysterectomy ?

A

Fibroids–> leiomyoma

85
Q

Days prior to surgery do we need to stop NOAC?

A

2 days

- 5 days for warfarin

86
Q

Calculation for serum osmarlarity?

A

2x Sodium + 2x K+ +Glucose/18 + BUN/2.8

87
Q

what type of lymphoma does Celiac put you at risk for?

A

T-cell

88
Q

Steps needed prior to lung resection for lung cancer?

A

PET/CT
EUS for mediastinum eval
Bronch intraop
Pulmonary function tests

89
Q

Familial hypocalciuric hypercalcemia?

A

inativated calcium sensing receptor

- leads to hypocalciuria, hypercalcemia and normal vitamin D levels.

90
Q

When does male gynecomastia get concerning? 3 things? Needs further eval.

A
  1. Pre puberty or post puberty before elderly
  2. Size >4cm
  3. present for greater than a year
91
Q

When does DCIS need SLNB?

A 
High grade features
>4cm
multicentric disease 
palpable disease 
or needing mastectomy
92
Q

Difference between multifocal breast disease and multicentric?

A

Focal is different areas

- Centric is multiple quadrant involvement

93
Q

seven characteristics of Gail model?

A
  1. Age
  2. Age of first menarche
  3. Age of first child
  4. Family history (1st degree relatives with BC)
  5. Number of Past breast biopsies
  6. Past bx showing atypical ductal hyperplasia
  7. race/ethnicity
94
Q

Pregnancy available treatments? specific to each trimester.

A

first: only surgery (MRM). No chemo. No rads
early 2nd. surgery (MRM) and select chemo
late 2nd: can get most chemo, can do SLNB but no blue dye, surgery
3rd: same as late 2
- rads only after delivery
- first and early 2nd need MRM because you cant do SLNB

95
Q

Characteristis that stratisfy Phyloides?

A

number of mitotic events
cellularity
margins

96
Q

Can patient with prior rads get SLNB?

A

no

97
Q

Classic NCCN guidelines for SNLB?

A

clinical stage invasive T1-3 with clinically negative nodes

98
Q

percent of malignancy from blood nipple discharge based on age?

A

<40- 3%
>60 30%
- 3 and 30

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