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QBANK MIX > MIX 3 QBANK > Flashcards

MIX 3 QBANK Flashcards

1
Q

indications for melanoma sentinel lymph node biopsy

A

thickness greater than 1 mm

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2
Q

treatment of thymoma

A

all should be approached with aggressive surgical management regardless of symptoms

Including invasive thymomas with radical resection

Postoperative radiation can improve local recurrence if pericapsular invasion

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3
Q

perioperative management of myasthenia gravis patient for thymoma

A

stop Anticholinesterase inhibitor 72 hours before surgery - decrease his pulmonary secretions

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4
Q

Hodgkin’s lymphoma staging and associated cells

A

Reed-Sternberg

Stage I-single lymph node
Stage II-2 or more sites on the same side of diaphragm
Stage III-both sides the diaphragm, spleen is counted as involved lymph node tissue
Stage IV-disseminated and involved lymphatic organs

Constitutional symptoms designate B:
fever, weight loss, night sweats, pruritus

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5
Q

how are triglycerides processed

A

short and medium chain fatty acids

Tubes or by intestinal epithelium directly

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6
Q

how are longchain fatty foods processed

A

requires lipase
Transported in mixed micelles to enterocytes - then recent incised into triglycerides in the form of chylomicrons and the created in the intestinal lymph chyle

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7
Q

renal cell carcinoma risk factor, presentation, lap markers, site of metastases

A

major risk of smoking

Associated with paraneoplastic syndrome including:
Erythrocytosis
 parathyroid like hormone: PTHrp
 ACTH
Renton

LUNG most common site of metastases
Isolated metastases may be resected at time of operation

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8
Q

Treatment for renal cell carcinoma

A

radical nephrectomy

ONLY partial nephrectomy patient to require dialysis as a result of removing kidney

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9
Q

Brown-Séquard syndrome
presentation symptoms
Mechanism of injury
prognosis

A

injury to half the spinal cord

Ipsilateral loss of motor ( careful, this is opposite from brain)

Contralateral lots of pain and temperature

cause contralateral symptoms below level of injury:
Spinal thalamic
Posterior column

mechanisms of injury:
Disc herniation
Vasculitis and radiation exposure
Penetrating trauma

Prognosis: Variable

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10
Q

blood supply of cervical esophagus

A

inferior thyroid artery (branch of thyrocervical trunk from subclavian artery)

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11
Q

laboratory values associated with hemophilia

A

elevated APTT

normal PT and bleeding time

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12
Q

laboratory values associated with von Willebrand’s

A

increased bleeding time from dysfunctional platelets

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13
Q

laboratory values associated with vitamin K deficiency

A

factors 2, 7, 9, 10 protein C and S.

increased PT AND aPTT

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14
Q

trauma patient with hemophilia A which should be given

A

if no factor concentrate preparations care of

CRYOPRECIPITATE ( more concentrated in FFP)

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15
Q

fuel source for colon

A

Short chain fatty acids
butyrate
propionate
acetate

Large bowel is short

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16
Q

fule source for small bowel

A

glutamine

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17
Q

diagnosing Zollinger-Ellison syndrome

A 
gastrinoma
 fasting serum gastrin will greater than 100
 AND
and a basal acid output greater than 15
consistent with dx

Secretin stimulation test increased gastrin greater than 200 (110-120) confirms

Imaging:
Somatostatin scintigraphy greater sensitivity than all conventional studies combined

EUS high-sensitivity for detection of pancreatic gastrinoma

not good for duodenal gastrinom

If cannot find gastrinoma:
-hepatic vein sampling with calcium stimulation

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18
Q

left congenital cyanotic heart defect

A 
tetralogy of flow
Transposition of great vessels
Pulmonary atresia with intact VSD
Pulmonary atresia with VSD
Valvular pulmonic stenosis
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19
Q

management of wrist drop after mid humerus shaft fracture

A

presence of radial nerve palsy does not indicate surgical exploration in all cases

possible indications include:
Open fracture
Stab injury

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20
Q

most common cause mortality of cardiac transplant after one year

A 
atherosclerosis
Causes include:
Natural disease process
Diabetes
Hyperlipidemia
Smoking
Chronic immunosuppression
Opportunity to infection
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21
Q

first muscles to be paralyzed with neuromuscular blockade

A

facial muscles

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22
Q

first muscles to recover after neuromuscular blockade and

A

diaphragm

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23
Q

last muscles to be paralyzed after neuromuscular blockade

A

diaphragm

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24
Q

components innate immunity

A

complement system
Natural alar cells
Phaco sites
Epithelial barriers

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25
Q

physiologic response to tumor necrosis factor What is the source

A

cachexia

source:
Macrophages, monocytes, T cells

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26
Q

physiologic response to IL1

A

fever related to hypo-thalamus

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27
Q

physiologic response to IL-2

A

promotes T-cell perforation and immunoglobulin production

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28
Q

physiologic response to IL-4

A

T-cell differentiation B cell activation

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29
Q

physiologic response to GM-CSF

A

admits granulocyte and monocyte production from bone marrow stem cells

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30
Q

urine output goals myoglobinuria

A

2 cc per kilogram per hour

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31
Q

adverse event

A

injury the results medical management and result in measurable disability

this includes preventable and preventable - given the current state of knowledge

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32
Q

near miss

A

could have resulted in injury/accident

it was prevented by chance or intervention

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33
Q

latent error

A

condition of the system is removed from the adverse event

Insidious and may not become evident and telemetry series of events have cascaded into perfect storm

poor design, incorrect installation, faulty maintenance, or inadequate staffing.

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34
Q

Side effect and treatment of isoflurane blue dye

A

anaphylaxis

subcutaneous epinephrine

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35
Q

mechanism of magnesium sulfate for premature labor

A

competitive inhibition of calcium influx

tocolytic

also used a seizure prophylaxis and patient’s with preeclampsia

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36
Q

fibrolamellar hepatocellular carcinoma findings on imaging, labs, prognosis

A

more aggressive

Central fibrotic component-well-circumscribed
careful, focal nodular hyperplasia also has central scar

Neurotensin positive
AFP negative

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37
Q

and what type of shock is venous oxygen saturation increased

A

septic shock

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38
Q

where are pancreatic damage and activated

A

duodenum

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39
Q

enzymes are secreted in active form from pancreas

A

Amylase
Lipase
ribonuclease
deoxyribonuclease

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40
Q

A stone located in the common bile duct after cholecystectomy designated as recurrent at what time.

A

2 years after cholecystectomy

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41
Q

Maxillary torus

A

a symptomatic lesion of the hard palate

Benign osteoblastic tumor

Treatment only if symptomatic

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42
Q

Glioma ENT tumor

A

just lateral to nasal root-reddish firm noncompressible lobular lesions with cutaneous telangiectasia

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43
Q

Submucosa cleft palate

A

triad:
Bifid uvula
Notch at the junction of the hard palate and soft palate
zona pellucida - thin layer of mucosa in the midline the soft palate

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44
Q

workup pyloric stenosis

A

diagnosis can sometimes definitively be made with physical exam alone

Ultrasound:
Thickness 3-4 mm
Length 15-18 mm

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45
Q

pyloric stenosis presentation

A

male female-4:1

First born male

Hypochloremic hypokalemic metabolic alkalosis

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46
Q

Pyloric stenosis treatment

A

after resuscitation
potassium is not replaced until intravascular volume had been restored with normal urine output

Microscopic pyloromyotomy

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47
Q

Most important prognosis factor for 32-year-old female with well-differentiated papillary carcinoma

A

age!
Male under the age of 40 females under the age of 50

presence of metastases less important!

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48
Q

With the thyroid cancer prognostic is

A

AMES

age
Metastases
Extent of involvement
signs of tumor

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49
Q

spigelian hernia

A

BELOW arcuate line

Between semilunar line in the lateral edge of rectus

Covered via external oblique aponeurosis-difficult to palpate-CT scan

Surgery: Transverse abdominal incision over defect

All require operation

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50
Q

innervation of external anal sphincter

A

voluntary control

inferior rectal branch of the internal pudendal nerve
And
Peroneal branch of fourth sacral nerve

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51
Q

Innervation of the internal anal sphincter

A

Involuntary

Autonomic nervous system

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52
Q

half life of nutritional markers

A

albumin 21 days
Transferrin 8 days
prealbumin 1-2 days

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53
Q

treatment of patent ductus arteriosus

A

term infant 90-95% closed by 4 days

Preterm infant 80-90% closed by 30-37 weeks gestational age

Term infant Cox inhibitors ineffective

Premature infant Cox inhibitors effective

Asymptomatic PDA surgery between age 1-2:
VATS or transcatheter

symptomatic infant prompt closure

54
Q

lab marker associated with active hepatitis B infection

A

HBsAg
hepatitis B surface antigen

+1-10 weeks after infection

disappears in for-6 months but present impairment 5 chronic infection

HBcAg
hepatitis B core antigen
intracellular antigen not in C-arm

Detectable orally after infection and persist after recovery and in chronic infections

55
Q

laboratory markers associated with hepatitis B vaccination

A

Anti-HBs
anti-hepatitis B antibody

( but also appeared during window. After antigen disappears marked to recovery after hepatitis B infection)

56
Q

most accurate diagnosis of hepatitis B infection

A

quantification of hepatitis B DNA in the serum

57
Q

management of perforated appendicitis

A

percutaneous drainage and antibiotics if abscess or fluid collection demonstrated

this is not the treatment if there are peritoneal signs

58
Q

antibiotic use for appendectomy of

A

single perioperative dose most commonly

59
Q

when with broad-spectrum IV antibiotics and interval appendectomy in 6-12 weeks be reasonable

A

phlegmon present-this is not drainable collection and surgical intervention can be difficult acutely

some advocate early appendectomy in this population though

60
Q

Clark’s levels

A 
level I epidermis
Level II papillary dermis
Level III junction between papillary and reticular dermis
Level IV reticular dermis
Level V subcutaneous fat
61
Q

most common cause of renovascular hypertension

A

atherosclerosis

62
Q

Pathophysiology of hypertension with renal artery stenosis

A

decreased pressure in affarent barroreceptors
stimulate juxtaglomerular apparatus
activated ring and angiotensin axis

63
Q

pores of Kohn in alveoli

A

communication between alveoli

64
Q

at what age to alveolar production began

A

some months gestation and continued until 10 years

65
Q

lab findings associated with tree renal azotemia rather than an intrinsic cause of renal failure

A

urine sodium of less than 20 - this is consistent with the body trying to reabsorb sodium for water to follow.

FENa less than 1%

66
Q

lifetime risk of postsplenectomy sepsis without immunos

A

1-5%

67
Q

ovarian cancer staging

A

stage I-one or both ovaries only can be treated with resection alone

Stage II-extended involvement of tumor but limited to pelvis

Stage III-tumor involvement of the abdomen

Stage IV-distant metastases

68
Q

mechanism of action of Finasteride

A

competitive inhibition of:
5a-Reductase

decreased serum and intra-prostate levels of dihydrotestosterone

helps relieve bladder obstruction

69
Q

intraoperative parathormone assay

A

half-life 3-5 minutes

Within 10 minutes the excision:
50% drop of highest pre-excisional value indicates complete resection of hyperfunctional gland

70
Q

Management if PTH does not drop to 50% and 10 minutes

A

Confirmed there is remaining hyperfunctioning tissue

Does not imply that gland removed was normal

71
Q

treatment of undifferentiated spindle cell malignant fibrous histiocytoma of the bone

A

preop chemotherapy

Surgical resection

Most common site proximal tibia distal femur

72
Q

treatment of infected pseudocyst

A

aspirated not draining by CT guidance or ultrasound

Gram stain and culture

If infection present, external drainage using surgical or percutaneous technique

73
Q

cells responsible for contractile forces of the wound healing

A

myoepithelial cells

found in the basal layer of epithelium

74
Q

most common cause of primary hyperparathyroidism

A

adenoma

hyperplasia is less common - though seen in MEN 1 and 2a

75
Q

mechanism of dobutamine

A

only Beta adrenergic stimulation
using cardiogenic shock

low dose- beta one-contractility

high-dose-beta-2-vasodilation

76
Q

Marjolin’s ulcer

A

scar/burn squamous cell carcinoma

Majors have scars and burns

77
Q

treatment of Marjolin’s ulcer

A

surgical excision with 3-4 mm normal-appearing skin

Intraoperative frozen section

Surgery preferred and scarred or traumatized areas

Radiation is useful and high risk for recurrence after extensive surgical excision

Mohs procedure reserved for lesions with indistinct margins in areas where the important preserve skin

78
Q

with cell releases tumor necrosis factor alpha

A

macrophages

principal mediator for gram-negative response
TNF also responsible for cachexia

79
Q

femoral canal boundaries

A

superior-iliopubic tract

Inferior-Cooper’s ligament

Medial-lacunar ligament

Lateral-femoral vein (careful, overall location of femoral veins medial compared artery)

80
Q

first-order kinetic

A

elimination is directly proportional to blood concentration

most drugs follow this

81
Q

zero order kinetic

A

elimination is independent of the concentration

seen with alcohol

82
Q

SIADH physiologic findings

A

reabsorbing too much water
despite this, patient’s remain overall normal volemic

sodium retention in the kidney needs to concentrated urine

83
Q

what causes the periumbilical pain and acute appendicitis versus right lower quadrant pain pathophysiology of innervation

A

appendiceal luminal distention which activated visceral pain fibers causing the initial periumbilical pain

Peritoneal signs from inflammation her carried via somatic nerve fibers in the right lower quadrant

84
Q

management of gallbladder adenoma

A

symptomatic adenomas are resected laparoscopically unless suspicious for malignancy

Asymptomatic adenomas not concerning for malignancy are followed q.6 months with ultrasound

Enlarging adenomas are resected

85
Q

Suspicious for malignancy adenomas

A

greater than 1 cm
Greater than 3 in number
Sessile
Mucosal invasion on ultrasound

86
Q

nerve involved with numbness in the foot drop - findings and common etiologies

A

common peroneal

Motor deficit often worse and sensory

supracondylar fracture
Proximal tibial fracture
Knee dislocation

87
Q

gold standard test her insulinoma

A

72 hour fasting:
Him serum glucose and Ambien insulin concentration every 6 hours as collected and symptoms develop

Diagnoses is made if patient develops neural glycopenic symptoms and C-arm glucose is low her than 45 with CM insulin level higher than 5

C-peptide and Prolenes and confirm factitious causes

88
Q

mechanism of urokinase

A

all thrombolyzes agents packed by converting Prolenes on plasminogen to plasma and

TPA recumbent

Converts plasminogen to plasmin

89
Q

when is systemic thrombolysis used

A

acute myocardial infarction
Acute ischemic stroke
Massive pulmonary embolism

90
Q

mechanism heparin

A

ACTIVATES antithrombin 3

This accelerated rate the anti-thrombin inhibitor enzymes of coagulation:
Thrombin
Factor X a

91
Q

Organ of Zuckerkandl

A

most common site of pheochromocytomas

Anterior and lateral to distal abdominal aorta between takeoff of the inferior mesenteric artery and aortic bifurcation

92
Q

treatment of 1 cm anal margin squamous cell carcinoma

A

excision

IS not Niagara protocol

93
Q

treatment of recurrent squamous cell carcinoma of anal margin

A

possibly reexcision or APR

94
Q

indications for nigro protocol

A

intra-anal lesion
Invasion of sphincter
possibly greater than 3 cm

5 fluorouracil

Mitomycin-C

3000 cGy

95
Q

innervation of upper epiglottis

A

glossopharyngeal nerve

sensory pathway of gag reflex

96
Q

innervation of lower epiglottis

A

recurrent laryngeal nerve

97
Q

muscles innervated by recurrent laryngeal nerve

A

lower epiglottis

All the muscles of the larynx except for the cricothyroid

98
Q

type of innervation by superior recurrent laryngeal nerve

A

sensory! helps for feedback of pitch

99
Q

Mycobacterium avium

A

aerobic non spore forming motile past bacilli

pulmonary disease with intact immune system

Disseminated disease with immunocompromise

100
Q

Confirmation of disseminated Mycobacterium avium

A

culture positive:
Blood, bone marrow, liver, spleen

positive stool culture may just indicate carrier status

101
Q

most common clinical presentation of Meckel’s diverticulum in children

A

bleeding

102
Q

name of hernia with Meckel’s diverticulum and it

A

Littre’s hernia

103
Q

first step of workup for Stewart-Treves syndrome

A

incisional biopsy

104
Q

treatment of Stewart-Treves syndrome

A

wide local excision with or without chemotherapy or radiation

105
Q

what does the spinal accessory nerve innervated

A

sternocleidomastoid and trapezius

motor nerve only

106
Q

where he fibers originate from first spinal accessory nerve

A

cranial root and medulla

cranial fibers exit jugular foramen

found in posterior triangle

107
Q

normally distributed data

A

is perinephric

conforms to bell-shaped curved

108
Q

Treatment of entamoeba the histolytica liver abscess

A

metronidazole

109
Q

CT findings that differentiate entamoeba the histolytica liver abscess from pyogenic liver abscess

A

non-ring enhancing

110
Q

mechanism of Mycophenolate Mofetil

A

CellCept

Purine synthesis inhibition

inhibits inosine monophosphate dehydrogenase and blocks the proliferation of lymphocytes.

111
Q

major mechanism of corticosteroids and immunosuppression

A

inhibits cytokine gene transcription in macrophages

and inhibit cytokine secretion:
IL1
IL 6
TNF

suppress T cells

112
Q

mechanism of cyclosporine

A

inhibit cytokine symphysis
IL-2 3 4
INF gamma

113
Q

guidelines for intercranial pressure monitoring

A

post resuscitation GCS equal to or less than 8
and abnormal CT scan

Even with normal CT if:
H. greater than 40
History of hypotension
Abnormal motor posturing

consider inpatient with GCS of 12 or less who cannot be closely monitored clinically or CT scan demonstrates intracranial hypertension

114
Q

Blood supply of the lungs

A

dual blood supply

Deoxygenated blood from pulmonary artery

oxygenated blood from bronchial arteries

2 left-sided bronchial arteries and one right sided bronchial artery (careful, even though 3 lobes on the right)

origin of bronchial arteries:
Thoracic aorta or arch but can join with intercostals

Some of venous return is via pulmonary veins

115
Q

pulmonary sequestration

A

left more common for both

intralobar:
Within the lung parenchyma
 mediastinum
 posterior segments of the lower lobes
 SYSTEMIC vessels from infradiaphragmatic aorta
 found in inferior pulmonary ligament
Venous drainage through  inferior pulmonary vein but can be systemic veins
 workup: CT MRI more common than angio
 treatment: Segmentectomy or lobectomy

Extralobar:
Surrounded by separate pleural covering
more common extrapulmonary anomalies

116
Q

normal resting lower esophageal sphincter pressure

A

10–20

117
Q

Lower esophageal sphincter pressure during swallow

A

zero

118
Q

Normal resting upper esophageal sphincter pressure

A

50-70

119
Q

most common cause a splenic vein thrombosis

A

chronic pancreatitis

pseudocyst can also cause this

120
Q

neck step in management with palpable neck mass calcium of 15 elevated PTH

A

NO FNA

En bloc total parathyroidectomy with ipsilateral thyroidectomy

121
Q

management of delayed presentation of femoral artery trauma

A

in almost always be managed with direct repair.

122
Q

management of popliteal artery trauma

A

Popliteal artery injury usually require interposition grafting

123
Q

Management of isolated tibial vessel injury

A

No treatment needed as long as one out of 3 vessels patent

124
Q

Neonatal and prenatal testicle torsion

A

extravaginal-testicle and both layers of the tunica vaginalis rotate

May not produce symptoms the testicle was atrophied and salvage is rare

125
Q

testicular torsion and young adults and children

A

interventional-testicle and inner layer of tunica vaginalis rotate

Clinical diagnosis-no ultrasound needed

126
Q

Review most somatostatin neuromas originate

A

periampullary and ampullary region most common site
proximal pancreas
or pancreaticoduodenal groove

127
Q

Cloot triangle

A

common HEPATIC duct
Cystic duct
Free edge of the liver

Contains colon
Cystic artery

128
Q

was common site for VIP Oma

A

body and tail

129
Q

Most common site for glucagonoma

A

body and tail

130
Q

Treatment for squamous cell carcinoma of the volva

A

less than 1 mm depth wide local excision

Greater than 1 mm depth:
Radical vulvectomy extends to endopelvic fascia
2 cm margin
Bilateral inguinal node dissection

If the lesion is ipsilateral ipsilateral inguinal node dissection

Positive nodes or extension into vagina or anus requires adjuvant chemotherapy and radiation therapy

131
Q

with at what level does the innominate artery across the trachea

A

fifth tracheal ring

QBANK MIX (28 decks)

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