Maindeck_7448322 Flashcards
1
Q
Child’s Pugh Score
A
Billirubin, Albumin, INR, Ascites, Encephalopathy
2
Q
Criteria for transanal excision of adenocar
A
T0 or T1 (submucosa)< 3 cm< 30% circumferencePalpable on DRE (<8cm from anal verge)
3
Q
Tx for gallstone ileus
A
Stable and healthy- stone removal and take down fistulaUnstable- stone removal only!
4
Q
Tx of cholangiocarcinoma
A
- Upper 3rd- duct resection w/ partial hepatectomy2. Middle 3rd- bile duct resection + LADN3. Lower 3rd- Whipple*Locally advanced/unresectable- transplant
5
Q
Orientation of portal triad
A
Bile duct lateralHepatic artery medialPortal vein posterior
6
Q
Secretin vs. CCK
A
Both released by duoSecretin- duct cells –> bicarbCCK- acinar cells –> enzymes
7
Q
CCK
A
Release from duo (I cells)Fxn: GB and Pancreatic contraction.Gastric relaxation
8
Q
Replaced R/ and L hepatic
A
R- SMAL- left gastric
9
Q
s/e of silver nitrate, silver sulfadiazene, mafenide
A
Silver nitrate- eletrolytes disturbace (no sulfa)Silver sulfadizene- neutropenia, sulfaMafenide- met acidosis, sulfa
10
Q
Parkland formula
A
4 x weight x TBSA 1st 1/2 in 1st 8h2nd half next 16
11
Q
Rule of 9s
A
Each arm 9Each leg 18Ant belly 9, Post belly 9Each hand 1Ant face 4.5, Post face 4.5Genitals 1
12
Q
Cholangiocarcinoma types
A
1- below confluence2- at confluence3- R or L hep duct4- R and L hep duct5- multicentric
13
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)
14
Q
Layers of colon/rectum
A
- mucosa2. sub-mucosa3. muscularis propria4. serosa
15
Q
HNPCC inheritance
A
ADDefect in MLH/MSHBethesda criteria:
- 3x1d relative
- 2xgenerations
- 1x<50y
16
Q
Most abundant bacteria in the colon
A
Bacteroides fragiles
17
Q
CRC staging
A
stage 1- t1 to t2, n0stage 2- t3 to t4, n0stage 3- node involvementstage 4- m1
18
Q
CRC T and N
A
t1- SMt2- MPt3- xMP/subserosat4- invaden1- 1-3, n2- >=4
19
Q
Peutz-Jeghers
A
ADPx- intestinal hamartomas, pigmented oral mucosaStart screening at 25; scope q2 years
20
Q
Fuel for colonocytes
A
SCFA (acetate, butyrate, propionate)
21
Q
Insulinoma
A
Loc: throughoutPx: whipple’s triad
22
Q
Glucagonoma
A
Loc: distalPx: dermatitis, DRH, DM, nec mig erythema
23
Q
VIPoma
A
Loc: distalPx: watery DRH, hypoK, achlorhydria, inhibits gastrin
24
Q
Gastrinoma
A
Loc: gastrinoma triangle (CBD, panic neck, 3D)Px: refractory PUD, gastrin > 200 on sec stim test
25
Somatostatinoma
Loc: headPx: DM, gallstones, steatorrhea, block exo/endo pancreas
26
VHL
up regulation of vegfhyper vascular tumors
27
Li Fraumeni
p53 mutationbreast ca + soft tissue sarcoma
28
Cowden's
pten mutationbreast ca + thyroid ca + hamartomas
29
Tx of Zenkers
<2cm: circopharyngeal myotomy2-5 cm: myotomy +/- diverticulectomy>5cm: myotomy + diverticulectomy
30
Traction vs. Pulsion Diverticulum
traction- inflammation; all 3 layers; mid esopulsion- pressure; 2 layers; above circoph.
31
Tx of Barrett's
low grade dysplasia: repeat scope/bx in 6mhigh grade dysplasia: endoscopic mucosal resection
32
Types of esophogectomy
Transhiatal- laparotomy and cervical incision/anastIvor Lewis- thoracic incisions/anast
33
Achalasia
high LES pressureincomplete relaxationno peristalsis
34
DES
normal LES pressurenormal relaxationunorganized peristalisis
35
Nutcracker eso
high amplitude/long peristalsisnormal LES pressurenormal relaxation
36
Hormones that increase LES pressure
GastrinMotilin
37
Superior laryngeal nerve
motor to cricothyroidinjury: high pitch
38
Recurrent laryngeal nerve
motor to larynx excluding circothryoidinjury: hoarsness, airway compromise
39
Free water deficit
TBW x [(Na-140)/140]TBW = weight x .6 (men) or .5 (women)
40
Tx for hyponatermia
Acute sxatic: hypertonic salineHypervolemia: hypertonic salineEuvolemic and asxatic: free water restrictionHypovolemic: volume resuscitate w/ LR or NS
41
Tx of SIADH
fluid restrictiondemeclocycline
42
Calcitonin
Parafollicular C cells Inhibits osteoclast resorptionIncreases Ph excretion
43
Succinylcholine
MOA: depolarizing muscle relaxantrapid on and off (RSI)s/e- hyperkalemia, can't reverse, peaked t waves
44
Loop diuretics vs. Ca sparing diuretics
loop- furosemideCa sparing- thiazides
45
421 rule for mIVF
4 ml/kg/hr for 1st 10 kg+2 for next 10-20+1 for every kg above 20
46
Hypocalcemia
tinglingchvostek/trousseau signEKG- qt prolongation and TWI
47
T staging for esophageal cancer
t1a- muscularis mucosat1b- SMt2- muscularis propriat3- adventitia*no serosa
48
Hypokalemia EKG
prolonged PR, TWI, qt prolongation
49
Hyperkalemia EKG
prolonged QRS, peaked T wave
50
Torsades
2/2 hypoK, hypoCa, hypoMgall cause qt prolongation
51
Markers:Cancer Ca 125bHCGAFPInhibin
Ca 125- epithelialbHCG- choriocarcinomaAFP- germ cell/endodermal/yolk sacInhibin- granulosa/sex-cord
52
Cervical neoplasia
CIN1- tx infection, close f/upCIN2- cryo or leepCIN3- cryo or leep
53
McVay repair
Hernia repair without meshApproximates TAA to cooper's ligament
54
Spigelian hernia
found along semilunar line lateral to rectusall should be repaired
55
Richter's hernia
protrusion and/or strangulation of part of the intestine's anti-mesenteric border
56
Octreotide
Somatostatin analogueInhibits exocrine function of pancreas and CCK releaseTx for chronic pancreatitis
57
long chain vs. medium chain TG
LC- absorbed by lymphaticsMC- absorbed into blood
58
Pseudocyst
encapsulatedlack epithelial lining>5cm requires drainage
59
Pancreas drainage procedures
Peustow- pancreaticojej (for large duct)Frey- pancreasticojej + core out headBerger- pancreatic head resection (for large head)
60
Atlanta classification pancreatits
1. Interstitial:
* <4w- acute peripanc collection,
* >4w psuedocys
t2. Necrotic:
* <4w- acute necrotic collection
* >4w- walled of necrosis
61
Tx of psuedocyst
<6cm and <6w --> conservative>6cm and >6w --> drain if sxatic (perc cath, endoscopic methods, or surgery)
62
Pancreatic ducts
Wirsung- major, lies inferiorSantorini- minor, lies superior
63
Hereditary pancreatitis
PRSS1 trypsinogen mut'nADsmoking cessation is important
64
Ranson's criteria on admission
"GA Law"age > 55Glu > 200LDH > 350AST > 250WBC > 16
65
Ranson's criteria at 48 h
"C and Hobbs"Ca < 8HCT down > 10 ptsO2 < 60Base deficit > 4BUN > 5Sequestration of fluids > 6L
66
Blood supply of pancreas
Head: superior PD and inferior PDBody/tail: splenic
67
MOA reglan and erythromcyin
reglan: dopamine antagonisterythromycin: motlin receptor agonist causing SM contraction
68
Indications for neoadjuvant therapy for stomach cancer
Any T2 lesion or LN involvementT2: growth into the muscularis propria
69
T staging for gastric cancer
t1- SMt2- MPt3- xMP/subserosat4- invaden1: 1-2, n2: 3-6, n3: >7
70
Number of LN needed for gastric vs. CRC
gastric- 15CRC- 12
71
Somatostatin
D cells in stomach, duo and pancShuts off insulin, glucagon, and gastrinStimulated by acid
72
Marginal ulcer vs. Cameron ulcer
Marginal- REYGB at GJ anastomosisCameron- on lesser curve of large hiatal hernia
73
Triple therapy
PP1 + 2 antibioticsabxs: amoxicillin, metronidazole, tetracycline, clarithromycin
74
Loss in excess weight for each surgery
REYGB- 75%SG- 60%Lap band- 50%
75
Gastrin
G cells of antrum signal EC cells --> His --> Parietal cell --> HClStimulated by ACh, beta ago, AA
76
Types of vagotomy
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
77
location of vagus nerve
LARPleft anterior, right posterior to esophagus
78
Tx of GIST
Resection w/ gross marginNo LN dissectionAdd imatinib (TK inhibitor) if >5m/50HPF
79
Fuel for SB and LB
SB- glutamineLB- SCFA
80
Specific to Crohn's disease
CobblestoningGranulomasTransmural Fistulas
81
Kaposi's sarcoma
HSV8Violet/brown papules
82
ITP
Cause: autoab to PLTSTx: steroids --> splenectomy (avoid PLTs)
83
Who needs stress dose steroids
>20 mg of steroids for > 3 weeks
84
Encapsulate organisms
Strep pneumo (MC)NeisseriaHaemophilus
85
Carcinoid vs. GIST origin and tx
carcinoid- Kulchinsky cells (enterochromaffin-like)
* < 2cm --> appendectomy
* > 2cm --> R hemi
* chemo if unresectable GIST- cajal cells
* tx- resection
* imantinib
86
Localization studies pheo, aldo, gastronoma, PT
pheo- i131aldo- adrenal vein samplinggastrinoma- SS receptorPT- sestamini
87
Order of potency of steroids
* HC
* Pred
* Methylpred
* Dexameth
88
Products of anterior pituitary
TSH, ACTH, FSH/LH, GH, Proneurosecretory cell stimulates hypothalamus which lets go of releasing hormone
89
Products of posterior pituitary
"PAO in the POST"ADH, Oxytocin2/2 direct stem from neurosecretory cell
90
When to operate on adrenal mass
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
91
Imaging associated with benign adrenal mass
< 10HURapid washout< 4cm
92
Bethesda criteria for thyroid
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
93
Staging adrenal cancer
s1- <5cms2- >5cms3- n1 or t3s4- mets
94
Origin of med thyroid cancer
4th pharyngeal arch NCC --> parafollicular C cells
95
Indications for radioiodine thereapy
2-4 cm massvascular invasionanti-Tg AbTG < 5
96
What is not suppressed by high dose dexa
Adrenal massEctopic mass (small cell cancer)
97
Sub-acute thyroiditis
Recent viral URI tx- NSAIDs/steroids
98
Hot vs. cold nodules
Hot- surgery or iodine ablation --> unlikely cancerCold- FNA --> may be cancer
99
Drainage of gonadal veins
R- IVFL- L renal vein
100
MCCO cauti
1. e. coli2. enterococcus3. candida
101
Tx of renal cell carcinoma
resistant to chemo/rads1st line is TK inhibitors (sunitinib)
102
Ureter injuries
proximal ⅓ → primary ureterourostomymiddle ⅓ → primary or tran uretero urosotomylower ⅓ → re-implanation +/- hitch
103
tacro
MOA: calcineurin inhibitor (binds fK)s/e- nephrotoxic
104
cyclosporine
MOA: calcineurin inhibitors/e- 100x less potent then tacro, nephrotoxic
105
MMF
MOA: cell cycle inhibitor
106
basiliximab
MOA: IL2 inhibitor
107
sirolimus
MOA: mTOR inhibitors/e- lymphocele, wound complicationsbenefit- less nephrotoxic
108
Types of rejection
hyperacute- preformed IgG against donor; t2HSacute- T and B cell resposne to MHC; t4HSgraft vs. host- graft T-cells attach host; t4HS
109
FRC
Volume of the lung after normal tidal expiration
110
Order of contents in thoracic outlet
vein (SC)muscle (scalene)artery (SC)nerve (br plexus)
111
Acute cellular rejection
T cell mediatedpath: portal cellular infiltrate + endotheliitistx: pulse steroids → consider thymo
112
Milan criteria
indications for trx w/ HCC
* Single tumor < 5cm
* No more than 3 tumors each < 3 cm
5-year transplant pt survival is 65-90%
113
hypovolemic shock
low CI, high SVR, low wedge
114
septic shock
high CI, low SVR, +/- wedge
115
cardiogenic
low CI, high SVR, high wedge
116
neurogenic shock
high CI, low SVR, low wedge
117
Grading of splenic injury
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
118
Post splenectomy ppx
"SHiN"PPV23 + haemophilus influenzae TYPE B + meningococcal polysaccharideElectively- 2 weeks beforeEmergently- PPV23 directly postop, other two given 2 w post op
119
GCS eye opening
4- spon3- to voice2- to pain1- none
120
GCS verbal
5- normal4- confused3- inappropriate words2- incomprehensible1- none
121
GCS motor
6- obeys commands5- localized4- w/draws3- flexion (decort)2- extension (decerebrate)1- none
122
Zone injuries
penetrating:
* zone 1-3 --> explore
blunt:
* zone1 --> explore
* zone 2-3 --> do not explore
123
Mattox maneuver
"L --> Mattox"move left structures to the rightexposure left sided vasculatreexplore aorta and L renal vein
124
Hard signs of vascular injury
shockexpanding hematomapulsatile bleedthrill/bruitabsent pulseischemia
125
TASC classifcation
TASC a and b usually get endovascular repairA- < 3cmB- 3-10 cm
126
Rule of 6s
flow > 600/mindiameter > 6mm (after placement)depth of 6mm
127
Indications to tx ICA stenosis
if Asx, only tx if > 60if sx, tx if > 50sxs- contralateral motor/sensory sxs, ipsi vision sxs
128
Central cord syndrome
loss of pain, temp, motormotor UE> LE loss (vs. anterior syndrome)
129
MC aortic infections
aneurysmal- staphnon-aneurysm- salmonella
130
Paget Von Schroetter syndrome
narrowing of SC/Ax vein 2/2 mech compressionpx- acute swellingTx- catheter directed thrombolysis (NOT open thrombectomy)
131
Indications for iHD
GFR 10-15 for sxaticGFR < 5 for asymptomaticSxs = AEIOU (acid, lytes, intox, olverload, uremia)
132
c/i to BCT
multicentricinflammatory cac/i to radiation
133
Modified radical mastectomy
mastectomy with ALND (level 1 and 2 only) w/ sparing of pectoralis
134
Gail model
ageage 1st periodage 1st birth1d relativeprevious bxrace
135
Tx of breast CA in preg
partial mastectomy + radiation after preg OR full mastectomytrastuzumab is c/i
136
Mondor disease
tender, “cord-like” structuretx- NSAIDs
137
Stage 3 breast CA
3a: 4-9 LNs3b: t4 disease (extension beyond breast)3c: 10+ LNs
138
Indications for neo-adjuvant therapy for breast CA
stage3+ or inflammatory breast
* CA 3a: 4-9 LNs
* 3b: t4 disease (extension beyond breast)
* 3c: 10+ LNs
139
long thoracic nerve vs. thoracodorsal nerve
LTN → serratus --> winged scapTD → LD --> difficult shoulder ADduction/Int rotation
140
Screening guidelines for breast ca
annual screening at age 40
141
Phyllodes tumor
“sarcoma of the breast”tx- en bloc resectionhematog spread- chemo/LN dissection unnneccesary
142
Benign lesions that require excisional bx
* Atypical DH
* Atypical LH
* LCIS
* radial scar
* papillary lesion
* any atypia
143
Intraductal papilloma
MCCO bloody nipple d/ctx w/ duct excisionno increased r/o ca
144
Fibroadenoma
cyclical paindx- US guided core bxonly excise if discordance with biopsy!
145
Stewart-Treves syndrome
post mastectomy lymphangiosarcomarare and highly malignantTx- wide local excision w/ 3-6 cm margin
146
Tx preg with hormone positive breast CA
part mastectomy, SLNBx w/ radio tracer (not meth blue)RTx after birth
147
TRAM flap
SUPERIOR epigastric arterycan use ipsi or contra muscle
148
Normal values: CVP, WP, SVR, CI
CVP 2-6WP 4-12SVR 700-1500CI 2.5-4
149
TLV
TLV = RV + ERV + TV + IRVFRC = RV + ERVIC = TV + IRV
150
ARDS ratio
P/F
* mild- 200 to 300
* moderate 100-200
* severe < 100
151
Arterial content
(1.34 x Hb x Sa02) + (.003 x PaO2)
152
Milrinone
PD inhibitorcontractility with vasodilationgreat for pulmonary hypertension
153
Midodrine
a1 agonist
154
Dopamine dosing
low- d1/2 ago (renal dose)medium- B agohigh- A ago
155
MC uni-microbial CO nec fasc
Clostridium perfringensgas gangreneanaerobic
156
Human bite tx
amox/clavulanateMC for human bites- eikenella
157
MCCO healthcare infection:
* HAP
* central line infection
* SSI
* UTI
* GI infection
* HAP: staph
* central line infection- candida
* SSI- staph
* UTI- e. Coli
* GI infection- c. diff
158
MRSA tx
vancomycinif vanc resistant then linezolid
159
Echinococcal cyst
hydatid diseasemultiple small cysts w/in big oneTx- total/partial splenectomy. can sterilize w/ EtOH injxn; spillage causes anaphylaxis (do not drain)
160
Staph epi
exo slime/biofilm from PIA capsuleblocks abx effect
161
Group A strep
strep pyogenessuspect if gas and bullae
162
LIPID A
Gram negative bacteria (Klebsiella) have outer lipopolysaccharide layer with LIPID A endotoxin → septic shock
163
PEAK and TROUGH
PEAK- amountTROUGH- frequency
164
Primary lymphoid organ vs. secondary
Primary: generate cells i.e. liver, bone, thymusSecondary: maintain cells i.e. nodes, spleen, MALT
165
TNFa
produced by macrophages
166
Lipopolysaccharide
cell wall of GN bacteria endotoxinactivates complements cascade → sepsis
167
Wound healing order of entry
plts → PMNs → macrophages → fibroblast → keratinocytes
168
Fibrolamellar HCC
well circumscribed w/ central scar similar to FNHnormal AFP and elevated neurotensin (Vs. FNH)
169
hepatic adenoma
path- EARLY HETEROGENEOUS enhancement on A phase w/ rapid washouttx- stop OCP use. resect if > 5cm or sxatic
170
FNH
path- CENTRAL STELLATE SCAR!; bright on arterial phase homogenoustx- resect if sxatic. no malignant potential.
171
bile salt circulation
* 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
172
Hemangioma
path- PERIPHERAL ENHANCEMENTtx- if rupture, size change, or KM syndrome
173
Kasabach-Merritt Syndrome:
hemangioma + thrombocytopeniausually infantsresect!
174
Entamoeba histo
MExicotx with MEtronidazole (no OR!)NO rim enhancement (vs. amoebic abscess)dx- EIA (assay)
175
Echinoccocus
Hydatid cysttx w/ mebendazole
176
Pyogenic abscess
e. Coli and klebtx- perc drainage is 1st line!
177
MCCO of spontaneous bacterial peritonitis
E. Coli
178
Hepatitis seromarkers
Vaccinated: surface Ab POSITIVEResolved Hb infection: surface Ab POSITIVE and core Ab POSITIVEActive infection: surface Ag, surface Ab, and core Ab ALL POSITIVE
179
Liver lesions on arterial phase:
* HCC
* Mets
* Adenoma
* Hemangioma
* FNH
* HCC- Homogeneous enhancement
* Mets- Hypoattenuation
* Adenoma- Heterogeneous enhancement
* Hemangioma- Periph enhancing
* FNH- Centrifugal enhancing
180
Mucoepidermoid carcinoma
MC malignant H/N tumor
181
Pleomorphic adenoma
MC benign H/N tumormiddle aged womanslow growing; t2 brightTx: superficial parotidectomy even if asx
182
Adenoid cystic carcinoma
MC minor salivary gland tumor (SM gland)propensity for perineural invasionRemains quiescent for years then metastasizes aggressively
183
Warthin tumor/Papillary cystadenoma
benign tumor of salivary glandoften BILATERAL and 2/2 smokingTx- complete resection with uninvolved margins even if ASx
184
CN11
spinal accessory nerveexit jugulars forameninnervates SCM and trapezius goes along post triangle
185
Contents of post triangle
CN 11 subclavian arteryEJVbrachial plexus trunks
186
Contents of ant triangle
carotid sheath, anca cervicalis, CN 12Contents of carotid sheath: CN10 (vagus), CCA, ICA
187
Frey syndrome
gustatory sweating s/p parotidectomy
188
Felty syndrome
rheumatoid arthritis, splenomegaly, granulocytopenia
189
LeFort fxs
I- palateII- nose and palateIII- entire face
190
Pyoderma gangrenosum
associated w/ IBDRESOLVES after resectionpre-tibialtx- steroids
191
Merkel cell ca
rare neuroendocrine tumor of the skinlooks like BCC w/out rolled edgeshighly radiosensitiveTx- surgical excision + SLNBx + XRT
192
SLNBx for melanoma
< .75 mm none> .75 to 1 mm w/ ulceration, mitosis, invasion
193
Stage 1 melanoma
1A: .76-1mm w/ no ulceration, no mitosis1B: mitosis, invasion, ulceration
194
Breslow depth
t1: < 1mm → .5-1 cm margint2: 1-2 mm → 1-2 cm margint3: > 2 mm → 2 cm margin
195
Vitamin C
hydroxylation of lysine and prolinetype 3 collagen cross-linking
196
Gardner’s Syndrome
ADpolyposis, osteomas, multiple epidermal cysts
197
Minimum negative margin for BCC
4 mm for unaggressive8 mm for aggressive tumors
198
Melanoma types
superficial spreading- MClentigo- sun exposed, best prognodular- worst prog
199
MS vs. ED
MS- Fibrillin defect (elastin); AD, tall, aortic root dilation, lens defect, arachnodactylyED- t1, t3 , t5 collagen defect; hyper elastic skin, hypermobile joints
200
ASA
irreversible inhibitor of PG metabolism in PLTs2/2 cox acetylation7-days of PLT dysfunction
201
VW disease
1- low quantity. tx- desmo and cryo2- low quality: tx- only cryo3- complete absence: tx- cryo and desmo dx- ristocetin test or measure vWF level
202
Heparin
accelerates AT3 activity and INDIRECTLY inhibits thrombin
203
Mechanical valve periop
restart coumadin in 12-24h and bridge w/ heparin or lovenox
204
ITP
px- petechiae and megakaryotcytestx- steroids (IVIG 2nd line)
* do not tx unless PLT < 30k or 20k in low risk
205
TTP
path- def in ADAMtS13px- TCP purpura, neuro sx, kidney dz, hemo anemia, fevertx- plasmapheresis → splenectomy if failed
206
F11 def
r/o bleeding w/ surgerytx- FFP (not f11 concentrate!)
207
Rapid coumadin reversal
PCC
208
VWF
binds GP1b on PLTs and attaches them to endothelium
209
PLTs
release txa2 → PLT aggregation
210
TXA2
vasoconstrictorsreleased by PLTs
211
Fibrinogen
binds gp2b/3a receptors to link PLTs together
212
Thrombin
converts fibrinogen to fibrin
213
Epoteitn
stimulated by HYPOXIA produced by kidney fibroblastsLiver is major producer of EPO in fetus
214
Hemophilia A
f8 DEFICIENCY SLRMC inherited disordertx- DESMOPRESSIN (mild), f8 concentrate (severe)
215
F5 Leiden
resistance to protein C and Sacts w/ Xa to converts fibrinogen to fibrin
216
Felty Syndrome
RA + neutropenia + splenomegaly
217
Wiskott-Aldrich Syndrome
X-linkedTCPenia + combined b/t cell def + eczema
218
AT3 def
ADnon-vit K dependent protease for 10a potentiated by heparintx- FFP
219
febrile transfusion rxn
RECIPIENTS Ab attack DONOR leukocytes
220
Plasmin
degrades fibrin and fibrinogenactivated by urokinase and streptokinase
221
Uremic PLT dysfunction
2/2 renal diseasereversible dysfunctiontx- desmopressin, cryo, conj estrogen, EPO, or blood DO NOT give PLTs
222
MALT lymphoma
associated w/ h. Pylori. Tx:
* Low grade: triple therapy
* High grade: chemo and XRT (CHOP) +/- rituximab
223
Interleukins 1, 2, 4
IL1: feverIL2: T cell prolif and Ig productionIL4: T/B cell maturation
224
Sarcoma T and N staging
T1- <5 cmT2- > 5cmN1- regional nodes
225
Ovarian tumor markers:AFPCEAHCGLDHCa 125Inhibin
AFP: yolk sac tumor, endodermal sinusCEA: mucinous ovarian tumorHCG: ovarian choriocarcinoma, embryonal carcinomaLDH: dysgerminomaCa 125: epithelial ovarian tumorsInhibin: granulosa cell tumor
226
EBV associated with
Burkitt lymphomaB cell lymphoman/ph cancer
227
Imatinib
competitive inhibitor of TKtx for GIST
228
T staging for HCC
T1: any size without vascular invasionT2: < 5 cm with vascular invasionT3: > 5 cm with vascular invasionT4: invade adjacent organs
229
Origins of medullary thyroid cancer
4th pharyngeal arch releases NCC which form parafollicular C cells
230
Indications for post op radio-iodine
2-4 cmvascular invasionanti-Tg AbTG<5
231
hot vs cold nodules
hot- surgery or iodine ablationcold- FNA
232
neoadjuvant tx for RCC
TK inhibitors are 1st line (sunitinib)Resistant to chemo/rads
233
MOA of tacro, cyclosporine, sirolimus, mmf, basiliximab
tacro- calcineurin inhibitorcyclosporine- calcineurin inhibitorsirolimus- mTor inhibitormmf- cell cycle inhibitorbasilixamab- il2 inhibitor
234
TOF anomalies
* Over-riding aorta
* RV hypertrophy
* VSD
* RV obstruction
235
Beckwith Wiedmann Syndrome
3m-2yAssociated with hepatoblastoma and wilm's tumor
236
5Ts of cyanosis
* TOF
* Transposition of GVs
* Truncus art
* Tricuspid atresia
* TAPVC
237
type 1 choledochocal cyst
fusiform dilationtx- excision w/ REY H-J
238
type 2 choledochocal cyst
cystic diverticulatx- excision w/ primary closure (NOT a REY)
239
type 3 choledochocal cyst
choledochoceletx- transduodenal marsupialization or excision
240
type 4 choledochocal cyst
extra/intra dilationstx- excision w/ REH H-J
241
Gastroschisis
GastRoschisis to the Right of midline rare defectsEXCEPTION- instestinal atresia
242
Omphalocele
2/2 failure of umbo ring closure 11th week gut returns to abdominal cavitynormal bowel (protected)Other congenital defect are more common
243
Non-cyanotic heart defects
ASDVSDcoarctation
244
Thoracic duct course
originates at L1-L2 @ c. chyli → aortic hiatus → cross from R to L at T4-5 → empties into L SC/IJ jxn
245
PFTs for lung resection
FEV1 > .8LDLCO > 40%FVC > 1.5LVO2 > 10 ml/min/kg
246
Mediastinal tumors
Anterior: lymphoma MC in children, thymoma MC in adultsMiddle: lymphoma MCPosterior: neurologic MC
247
Cutoff for low risk lung nodules not requiring follow-up
6mm
248
Number of lung segments
R-10L-8
249
Lung fissures
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
250
Accessible nodal stations w/ EBUS
2, 3, 4, 7, 10, 11, 12
251
Thyroid ima
supplies medial aspect of both lobes of the thyroidcome off the innominate/brachiocephalic
252
Cisatracurium
non-depolarizingcleared by Hoffman degradationuse in pts w/ renal and hepatic disease
253
Vecuronium
non-depoleliminated by kidney and liver
254
Pancuronium
non-depoleliminated by kidney and liver
255
Rocuronium
non-depolrapid onset; best for short procedureseliminated by liver only
256
Succinylcholine
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
257
Tx for beta blocker overdose
glucagon
258
Steps of rapid sequence intubation
c-spine stabilize → preO2 → fentanyl → etomidate → succinylcholine
259
Atropine
competitive inhibitor of ACh at muscarinic receptor liver metabolism
260
Neostigmine
reversal of non-depol muscle relaxantsAChE inhibitor
261
NO
little myocardial depressionrapid uptake and eliminationnot strong enough as single agent
262
Halothane
cheapesteffective at low concentrations/e- ventricular arrhythmia, hepatic necrosis
263
Sevoflurane
rapid inductions/e- expensive, liver metabolism
264
Isoflurane
strong vasodilatorless myocardial depression (still more than NO)
265
Latent error
2/2 condition of system being removed; evident after a “perfect storm”
266
SCIP guidelines
* 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
267
Periop DM management
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 scale
Intermediate/Long acting:
* give normal dose the night before
* Give ½ dose the morning of surgery
Pump: keep a basal insulin infusion on the day of surgery - use pump to correct levels as needed
268
Peri-op anti-PLT agents
Clopidogrel (plavix): hold 5-7 days before elective surgeryASA: continue through the surgery
269
Epidural hematoma
BiconvexMMADOES NOT suture lines
270
CPP
MAP - ICP
271
Vitamin K
gamma CARBOXYLATION (not decarb) of GLUTAMATE on 2, 7, 9, 10, c, s
272
Warfarin
competitive inhibitor of epoxide reductase (vit K activator)
273
Kcal per macronutrient
protein = 4 kcal/gdextrose = 3 kcal/glipid = 4 kcal/gcarb = 4 kcal/g
274
Glycogen
stores depleted after 24-48h of starvationMOST found in skeletal muscle, rest in the liver
275
Zinc def
skin rash, impaired wound healing, testicular atrophy
276
Selenium def
cardiomyopathy, hypothyroid
277
Chromium
hyperglycemia, confusion, neuropathy
278
Copper def
pancytopenia, myelopathy, pigmentation change
279
Iron def
anemia, glossitis, brittle nails, cardiomegaly
280
B12 def
megalo anemia, neuropathy
281
Respiratory quotient
CO2 produced / O2 consumed>1 → carb is major nutrient.7 → lipids major nutrient
282
preA vs. Albumin
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
283
Silvadene, mafenide, silver nitrate s/e
Silvadene: s/e- neutropenia, hypersensitivity, kernicterus (avoid in preg)Mafenide: s/e- met acidosisSilver Nitrate: s/e- hypoNatremia
284
neostigmine
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
285
Reversals:
* BB
* Tylenol
* Benzos
* CN/Nitroprusside
* Vecuronium/Rocuronium
* Ethylene glycol
* Methemoglobinemia
* BB overdose: fluids/atropine → glucagon
* Tylenol: NAC
* Benzos: fluamzenil
* CN/Nitroprusside: sodium thiosulfate, amyl nitrite
* Vecuronium/Rocuronium: sugammadex
* Ethylene glycol: femopizole and bicarb OR ethanol; iHD
* Methemoglobinemia: methylene blue
286
Ethylene glycol toxicity
metabolized in the liveroxalate stones → renal failureanion gap met acid
287
SD
1, 2, and 3 SD = 67%, 95%, and 99.7% of the data
288
Se, Sp
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
289
PPV, NPV
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
290
NNT`
NNT = 1/absolute risk reduction (ARR)ARR = event rate in intervention group - rate in null group
291
type 1 vs. type 2 error
type 1: false positivetype 2 false negative
292
T and N staging eso cancer
* t1a- LP and MM
* t1b- SM
* t2- MP
* t3- adventitia
* t4a- resectable structures
* t4b- unresectable structures
n1: 1-2 nodesn2: 3-6 nodesn3: 7+
293
Indications for neoadjuvant therapy eso cancer
t1b and above ORany nodal involvement
294
tx of eso cancer by t stage
t1a- mucosal resectiont1b- esophagectomyt2- esophagectomyt3- esophagectomyt4a- esophagectomyt4b- chemo/radscervical- chemo/rads
295
layers of the eso
```
Mucosa
* epithelium
* LP
* MM
* Sub-mucosa (lots of lyphatics!)
* MP
* Adventitia
NO serosa!
```
296
T staging indications for neoadjuvant- eso- stomach- colon- rectal
- eso: t1b (SM)- stomach: t2 (MP)- colon: t4b (adjacent organs)- rectal: t3 (through MP)
297
Tx of liver lesions
* Hemangioma: only if sxatic FNH: NTD
| * Adenoma: if > 4cm or < 4cm w/out OCP reponse
298
Liver collection tx
Pyogenic- drain and abxAmoebic- metronidazoleEchinococcal- albendazole and resect
299
MELD
* Bili
* INR
* Creatinine
300
Enzymes secreted in their active form from pancreas
AmylaseLipaseRibonucleaseDeoxyribonuclease
301
Stage 3 breast cancer
3a- 4 to 9 nodes3b- chest wall or breast skin3c- supra clavicular nodes
302
Howship-Romburg Sign
Pain in medial thigh with internal rotation and extensionSuggests an obtruator hernia
303
dx of colovag and colovesic fistula
colovag: tampon testcolovesic: CT scan
304
Scope schedule after Crohn's dx
10 years after dx then every year to r/o dysplasia
305
Paget-Schroetter syndrome
Exercose induced thrombosis of subclavian/axillary VEINTx- catheter directed thrombolysis
306
Generic nitrogen need
1g of nitrogen for every 150 kcal
307
clostridua
GPRMC CO emphysematous cholecystitis
308
Treatment of Merkel Cell
excisionhighly radiosensitive. radiate if > 2cmSLNBx
309
Gardner syndrome
epidermal cysts, GI polyposis, osteomas
310
Hyperacute rejection mechanism
Host IgG towards class 1 MHC
311
Cause of:gravesTMNHashimoto'sDeQuervains
graves- IgG against TSHrTMN- hyperplasia 2/2 low grade TSH stimulationHashimoto's- antiTG abs (cell-med and humoral)DeQuervains- viral URI
312
Specific to UC
Crypt abscessPsuedopolyps
313
Specific to Crohn's
Creeping fatSkip lesionsTransmural
314
Polyps that require surgery instead of endoscopic resection
Submucosal invasion > 1mmPoorly differentiated<1 mm marginLymphovascular invasionTumor budding
