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QBANK MIX > MIX 4 QBANK > Flashcards

MIX 4 QBANK Flashcards

1
Q

definition volvulus

A

twisted 180°

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2
Q

x-ray findings of a cecal volvulus

A

kidney shape

Bird’s beak

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3
Q

what vascular supply does cecal volvulus rotator around

A

ileocolic

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4
Q

treatment of cecal volvulus

A

right hemicolectomy with primary ileocolic anastomosis

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5
Q

treatment of advanced ovarian cancer metastatic

A 
resect so no tumor greater than 2 cm left
Debulk:
 multiple bowel resections
Radical hysterectomy-entire pelvic tumor mass
Bladder
Sidewall
Cul-de-sac
Titanium
Rectosigmoid

Approaches extraperitoneal ventral to dorsal technique

Splenectomy
Total omentectomy
Hepatic resection
Diaphragm peritoneal stripping

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6
Q

symptoms of lidocaine toxicity

A 
earlier signs-
tingling of the tongue and lips
 metallic taste
Lightheaded
tinitus
Visual disturbances

progressive signs-
Slurred speech
Disorientation
Seizures

Cardiovascular:
Widened PR interval
Wide QRS
Sinus tachycardia
Ultimately cardiovascular collapse
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7
Q

treatment of local anesthetic toxicity

A

oxygen airway support

If seizure does not terminate spontaneously:
Benzodiazepine (medazepam)
Or
Thiopental

cardiovascular support may be needed

Intralipid for Marcaine/ bupivacaine

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8
Q

workup for insulinoma and CT scan shows multiple lesions and pancreas

A

portal venous sampling for localization of highest functional tumors

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9
Q

management of zone one injury

A 
Central-
Diaphragm to sacrum
Renal hilum  lateral
 contained colon
Aorta
Vena cava
Portal vein
Proximal renal vessels
Anchors
Duodenum

Both penetrating and blood injuries with hematoma should be explored surgically

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10
Q

Zone 2 retroperitoneal injury

A

lateral

Renal hilum
Kidneys
Adrenals
Superior ureters

Blunt injuries and hematoma did not need to be explored

Left associated colon injury, urinoma, expanding hematoma

Stone to penetrating injuries with hematoma are explored

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11
Q

Zone 3 retroperitoneal injury

A 
inferior central - pelvis
Iliac vessels
Rectum
Distal sigmoid
Distal ureters

Stable non-expanding hematomas nonoperative

Hematomas from penetrating injury may need exploration

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12
Q

structures at risk with inferior esophageal mobilization for fundoplication

A

vagus nerve

Left hepatic artery coming from the left gastric can be encountered

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13
Q

Minor salivary gland tumors most common locations

A

90% malignant

Palate is the most common origin 50%

lip 15%

buccal mucosa 12%

tongue and floor of mouth 5%

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14
Q

minor salivary gland tumor tissue type in presentation

A

most
adenoid cystic carcinoma

signs of malignancy:

rapid tumor growth
Pain
Ulceration

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15
Q

Treatment of minor salivary gland tumor

A

surgical resection with adequate margins

Conclusion:
Involved mucosa
Muscle
Bone

 postoperative radiation if:
high grade
 positive margins
Perineural spread
Deep invasion into muscle bone
Lymph nodes
Metastases
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16
Q

what hormone is responsible for secretion of bicarbonate and stomach passes food into duodenum

A

secretary and

causes increased bicarbonate decreased chloride

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17
Q

Heineke-Mikulicz Strictureplasty indications and procedure

A

Crohn’s stricture
strictures up to 5-7 cm long
Longitudinal incision over stricture closed transversely

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18
Q

Finney strictureplasty indications and procedure

A

strictures up to 10-15 cm long

loop of stricture as doubled and incised and closed as functional side to side

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19
Q

diagnosis and young female on oral birth control pills with 6 cm liver lesion

A

hepatic adenoma

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20
Q

imaging findings of hepatic adenoma

A

early phase enhancement

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21
Q

the management of hepatic adenoma

A

symptomatic resect

Asymptomatic adenomas stopped oral contraception and followup

Resect before planned pregnancy

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22
Q

boundary of the femoral canal

A

anterior chest inguinal ligament
Posterior pectineal ligament
Medial lacunar ligament
Lateral femoral vein

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23
Q

what invasive maneuver often needs to be performed for management of femoral hernia

A

division of inguinal ligament to fully reduce the herniated bowel

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24
Q

splenic septated cyst workup and treatment

A

most common parasitic source:
echinococcus!

serology
splenectomy

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25
Q

asymptomatic non-parasitic splenic cyst

A

observed with ultrasound followed

Risk of cyst rupture even with minor trauma when large cyst

Small symptomatic non-parasitic cyst may be excised with a splenic preservation

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26
Q

Cancer most likely to metastasize the spleen

A

along

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27
Q

primary tumor most likely to be found and spleen

A

sarcoma

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28
Q

ischemic reperfusion injury after renal transplant

A

presentation maybe a 36 hours

acute tubular necrosis

treated with fluid resuscitation

may require dialysis

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29
Q

test to confirm vascular occlusion after renal transplant

A

radioisotope scanning and ultrasound

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30
Q

disseminated intravascular coagulation

A 
causes:
Trauma
Hemodialysis
Obstetric
Malignancy
Sepsis

thrombin and plasma INCREASE
causes bleeding and clot formation

Antithrombin III and plasminogen levels DECREASE

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31
Q

bacteria associated with emphysematous gallbladder and diabetes

A

Clostridium perfringens

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32
Q

Paget Von Schroeder syndrome

A

venous thoracic outlet syndrome
Effort thrombosis

Narrowing of the subclavian AXILLARY vein

At the level of the costoclavicular space

Most medial aspect of thoracic outlet

Sources of compression:
First rate
Clavicle
Subclavius
Costal coracoid ligament
Anterior scalene
Tubercle

If emboli occur: ARTERIAL

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33
Q

described first-degree burn

A

painful
Erythema
Blanche

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34
Q

Describes second-degree superficial burn

A

superficial dermis

Painful
Erythema
Blanche
blister

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35
Q

described deep second-degree burn

A

deep dermis

Painful
Do not blanch
Pale
Mottled

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36
Q

described third-degree burn

A

subcutaneous fat

 heart
Left artery
Eschar
PAINLESS
Black, White or RED
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37
Q

tetralogy of fallot findings

A

overriding aorta
VSD
Right ventricular outflow obstruction
Right ventricular hypertrophy

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38
Q

Management of irreducible inguinal hernia in newborn found to have ischemic bowel-operative approach

A

Our section can usually be performed through hernia sac!

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39
Q

Most common location and anatomy a hepatic artery And course

A 
and celiac trunk
Superior edge of the pancreas
Gastroduodenal artery
Right gastric artery
Courses into portal triad
 bifurcates into right and left
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40
Q

common variant of left hepatic artery

A

off of left gastric

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41
Q

localization studies insulinomas

A

EUS
CT scan - 40%-still done
intraoperative ultrasound most sensitive (careful, gastrinoma not that useful)

Also continues calcium angiography-calcium stimulates increase in tone secretion

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42
Q

criteria to diagnosis primary hyperparathyroidism

A

increased PTH
Increase calcium
Normal or elevated urine calcium (differentiate from familial hypercalcemic hypocalciuria)

chloride- phosphorus ratio: 33:1

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43
Q

superior vena cava syndrome

A

diagnosis CT
Bronchoscopy biopsy

Treatment:
Chemoradiation

surgery rarely possible due to great vessel involvement

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44
Q

CMV colitis

A

immunocompromised
Bloody diarrhea
Endoscopy with biopsy confirms

Treatment ganciclovir

Resection considered only with life-threatening ischemia or uncontrolled bleeding
Or
Peritonitis

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45
Q

Normal right ventricular pressure

appearance on EKG

A

20-30/0-8

square roots sign

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46
Q

normal pulmonary artery wedge pressure

appearance on EKG

A

6-15
smooth curves with low amplitude
loss of Dicrotic notch

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47
Q

mechanism of action of heparin

A

indirect thrombin inhibitor

ACCELERATES antithrombin III activity

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48
Q

aspirin mechanism

A

irreversible cyclooxygenase inhibitor

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49
Q

electrolyte abnormality seen after full resuscitation of burn

A

HYPER natremia

even though LR

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50
Q

lactated Ringer’s contains

A 
sodium 130
Chloride 109
Lactate 28
Potassium 4
Calcium 3
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51
Q

normal saline containing

A

sodium 154
Chloride 154
osmolarity of 308 mOsmol/L
Ascitic! PH 5.5

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52
Q

for epidemiology of trauma what our host, Vector, environment

A

Host-human
Vector-vehicle
Environment

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53
Q

primary spread of T1 adenocarcinoma esophagus

A

submucosal

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54
Q

treatment of N1 adenocarcinoma esophagus

A

en bloc resection

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55
Q

treatment of Merkel cell carcinoma

A

wide excision

Sentinel node for all

Radiation for all

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56
Q

Innervation of cricothyroid

A

external branches superior laryngeal nerve

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57
Q

innervation of hypopharynx

A

glossopharyngeal cranial nerve 9 and vagus nerve cranial nerve 10

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58
Q

course of superior laryngeal nerve

A

off the vagus and exit skull

This ends internal carotid artery

Divided hilar cartilage into internal and external branches

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59
Q

internal branch of superior laryngeal nerve

A

lateral thyroid membrane

Sensory after her fibers from the supraglottis and vocal folds

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60
Q

external branch of the superior laryngeal nerve

A

inferior constrictor anterior medial course

Along with the superior thyroid artery

Into the cricothyroid muscle-motor innervation

Separate from superior thyroid artery 1 cm proximal to arterial entrance of capsule superior pole thyroid

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61
Q

transposition of great vessels

A

associated:
VSD
Hypoplastic aortic arch

Cyanotic

Treatment FIRST with prostaglandin E. to keep ductus arteriosus OPEN

balloon septostomy can also help

death if untreated

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62
Q

increase risk of ovarian cancer

A

pain breast with estrogen exposure

including not breast-feeding

Family history of:
Colon
Breast
Endometrial

high-dose ovulation induction

peroneal talc use!

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63
Q

decrease risk of ovarian cancer

A

oral birth control

Tubal ligation

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64
Q

minimal alveolar concentration

A

alveolar concentration of inhaled anesthetic required to prevent movement and 50% of patients to noxious stimuli

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65
Q

initial trauma fluid bolus pediatric

A

20 mL per kilogram x2

then blood

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66
Q

inotropic agent used for pediatric sepsis that’s different then adults

A

epinephrine more commonly used and kids

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67
Q

stage IV sarcoma of the extremity

A

with regional node involvement!

any metastases

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68
Q

what lab finding is seen with 21 hydroxylase deficiency

A

incr 17-OH progesterone
(careful, don’t confused with 17-hydroxylse deficiency)

21 hydroxylase def salt wasting

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69
Q

most common at risk structure with posterior shoulder dislocation

A

axillary artery

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70
Q

signs of posterior shoulder dislocation

A

fixed internal rotation

X-ray findings may be so because humeral head directly posterior on AP view

CT scan most helpful

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71
Q

Treatment of posterior shoulder dislocation

A

immobilization and external rotation

Rate presentation requires open reduction

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72
Q

Structure at risk with anterior shoulder dislocation

A

axillary nerve

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73
Q

transanal excision of rectal cancer criteria

A

Local excision of a rectal cancer may be appropriate for a small cancer in the distal rectum that has not penetrated into the muscularis.

mobile tumors smaller than 4 cm in diameter, that involve less than 40% of the rectal wall circumference, and that are located within 6 cm of the anal verge. These tumors should be stage T1 (limited to the submucosa) or T2 (limited to the muscularis propria), well or moderately differentiated histologically, and with no vascular or lymphatic invasion.

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74
Q

sphincter relationship required for LAR

A

tumor greater than 2 cm from the sphincter muscle

the sphincter involved:
APR

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75
Q

rectal cancer approach that lower stent and postoperative complications

A

total mesorectal excision

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76
Q

criteria to transfuse platelets for ITP Undergoing surgery

A

only for significant bleeding

Alternative:
platelets less than 20 -
IV immunoglobulin x2 days

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77
Q

common cause of bleeding after Whipple- was treated in

A

gastroduodenal stump blowout - often caused by gastrointestinal anastomosis leak

embolization via hepatic artery

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78
Q

fetal circulation

A

oxygenated blood from placenta was into SINGLE umbilical vein

And 2 IVC

From right atrium to left atrium through the foramen ovale

and from right ventricle to pulmonary artery shunted through ductus arteriosus to aorta

de and oxygenated blood return to consent to be 2 umbilical arteries that come off internal iliac

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79
Q

contraindications to using nitrous oxide

A

small bowel obstruction

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80
Q

most common complication of renal stone And how can just be related to bowel resection

A

calcium phosphate

terminal ileum resection causes increased resorption of oxalate in the colon that is excreted in the urine

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81
Q

initial blood pressure management in the ascending thoracic aortic dissection

A

beta blocker
labetalol or propranolol

pressure remained above 100 pigmentation add nitroprusside

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82
Q

what is contraindicated in spinal cord injury

A

succinyl choline

hyperkalemia

also avoided in turn

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83
Q

cardiac findings with hyperkalemia

A

PVCs
Wide complex tachycardia
Torsade de pointes
Cardiac arrest

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84
Q

half life of insulin

A

7-10 minutes

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85
Q

Insulin response to oral glucose versus IV

A

or glucose much greater response increase of insulin

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86
Q

pleomorphic adenoma presentation and treatment

A

most common benign tumor of the salivary glands

90% of the parotid gland
superficial facial nerve
superficial parotidectomy

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87
Q

most common site of aspiration in the lung

A

right

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88
Q

treatment of one aspiration

A

most commonly antibiotics

If not cleared in 8 weeks surgery

Surgery indications:
Large cavities over 4-6 cm
Hemoptysis
Need to rule out malignancy

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89
Q

physiologic functions of parathyroid hormone

A

Inhibits calcium excretion distal convoluted tubules the kidney

Inhibits phosphate reabsorption
inhibits bicarbonate reabsorption

stimulates vitamin D production and kidneys

stimulated vitamin D conversion to active form

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90
Q

operative approach for open treatment of the Zenker’s diverticulum

A

LEFT neck

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91
Q

when is a myotomy alone sufficient to treat Zenker’s

A

diverticulum less than 2 cm

pexy of the diverticulum not needed

92
Q

criteria for endoscopic Zenker’s

A

2-5 cm diverticula

though can be performed less than 3 cm - the surgery is better when less than 3 cm in size

93
Q

Most common source of metastasis found in the small bowel

A

melanoma

94
Q

pulmonary artery occlusion pressure the indicates achieved blood volume expansion

A

stabilization between 15-20

95
Q

Purpose of using vasopressin and shock

A

treatment vasodilatory shock refractory to the infusion of alpha adrenergic agents alone

96
Q

Central cord injury

A

upper extremity weaker than lower extremity

patchy sensation

loss of reflexes

Mid to low cervical spine

history of spinal stenosis

Hyperextension

97
Q

anterior cord injury

A

infarction

Complete paralysis below injury

Preserved sensory from posterior column

98
Q

posterior cord injury

A

complete paralysis and loss of proprioception

loss of vibration

intact pain temperature and light touch

99
Q

Brown-Séquard syndrome

A

ipsilateral motor loss

Contralateral pain loss

Contralateral temperature loss

100
Q

imaging findings of hemangioma

A

most common benign tumors of the liver
(careful common not adenoma)

peripheral enhancement on arterial phase

‘out grows blood supply’

asymptomatic managed conservatively

101
Q

imaging findings of adenoma the liver

A

well circumscribed
heterogeneous

early enhancement an arterial phase

102
Q

where is greatest risk of placing tacks with laparoscopic inguinal hernia repair

A

inferior to inguinal ligament
Lateral to epigastrics

 risk:
Femoral branch of general femoral nerve
Lateral femoral cutaneous nerve
Spermatic vessels
Vas deferens
103
Q

first line treatment of endometriosis

A

oral birth control pills

Estrogen inhibitor such as danazol

definitive treatment hysterectomy

104
Q

action of CCK

A

gallbladder activity

 released from duodenum
 stimulated by:
Fat
Needle acid
Ascitic environment

Contracts gallbladder
RELAXES the sphincter of Odie

105
Q

Courvoisier’s sign

A

enlarged palpable gallbladder in patients with obstructive jaundice caused by tumors of biliary tree or pancreatic head tumors

106
Q

what size umbilical hernia as expected to close spontaneously in children

A

less than 2 cm

107
Q

type of immune response with hypersensitivity

A

type I

Anaphylaxis

108
Q

type II immune reaction

A

and a body IgG IgM

Hemolytic anemia

109
Q

type III immune reaction

A

antibody antigen complex

Serum sickness

110
Q

type 4 immune reaction

A

peak response 24-72 hours

Contact dermatitis

PPD

111
Q

CCK is released by work cells and where

A

I cells duodenum

112
Q

treatment for parathyroid cancer

A

en bloc resection
Total parathyroidectomy
ipsilateral thyroidectomy

113
Q

workup for refractory hypertension

A

working diagnosis of primary hyperaldosteronism:
Plasma aldosterone to plasma renin ratio 30

Absolute aldosterone 15

24 hour urine aldosterone

CT scan

CT scan unsuccessful:
Adrenal sampling-to not necessary in patient’s older than 40 with solitary adrenal mass greater than 1 cm and normal contralateral gland

114
Q

adrenal sampling positive

A

for times greater aldosterone to cortisol level on one side

115
Q

most common site of cervical cancer node metastases

A

internal iliac nodes

116
Q

most common site of endometrial lymphatic drainage

A

this is different from cervical drainage

Retroperitoneum:
Para-aortic nodes

117
Q

next best step in management for effort induced thrombosis

A

catheter directed thrombolysis
which has a high rate of restoring luminal patency

( careful, initial treatment used to be anticoagulation alone)

after pain patency reestablished catheter directed thrombolysis then do first rib possibly and same hospitalization

118
Q

Most important criteria to predict tolerating the pulmonary lobectomy

A

FEV1 greater than 0.8

other criteria:
PCO2 not greater than 45-50

DLCO Diffusion capacity not less than 40%

VO2 exercise tolerance not less than 10-12 mL/minute / of kilogram

119
Q

the FEV1 borderline with his next test to predict tolerating the pulmonary lobectomy

A

VQ scan

shows distribution of ventilation blood flow to each lobe

120
Q

CT finding of epidural hematoma

A

biconvex bordered by cranial suture lines
lenticular
location between skull and dura

Arterial injury

Lucid interval

121
Q

Acute subdural hematoma findings compared to chronic

A

biconcave crescent-shaped crossing over lateral suture but does not cross midline ( because of presence of falx)

tearing or bridging veins

Location between arachnoid dura mater

careful, chronic subdural fade to the density of the CSF

122
Q

lab findings of primary hyperparathyroidism

A

increase calcium
Decrease phosphorus
Increased PTH
Normal or INCREASED urine calcium

123
Q

diagnosis with diabetes associated with dermatitis-migratory

A

GLUCOGONoma

necrolytic migratory erythema

124
Q

location of VIPomas

A

body and tail

125
Q

location of gastrinoma in pancreas

A

body and tail

same as VIPoma

126
Q

diagnosis and treatment of glucagonoma

A

serum glucagon levels usually greater than 500

preoperative colon
Controlled diabetes, octreotide

Debulking

127
Q

treatment of abscess superior to dentate line

A

most common type of fistula

No external opening-Mae tract to rectal wall
We tracked to lower rectum
Passes within in the intersphincteric space

treatment:
Must find crypt or abscess originated-
Endoscopy, probing, sigmoidoscopy that’s rule out Crohn’s

The internal opening found-drained or fistulotomy

Approach may require incising mucosa and longitudinal internal sphincter muscle of rectal wall

Antibiotics none needed once drained

128
Q

cancer associated with vinyl chloride exposure

A

hepatic ANGIOSARCOMA

129
Q

colovesical fistulas more common in men or wome with diverticulitis

A

man because uterus acts as barrier

130
Q

pathophysiology of developing gastroischesis

A

associated with normal involution of the second umbilical vein

131
Q

anesthesia agents associated with malignant hyperthermia

A

inhaled volatile

depolarizing muscle relaxant

132
Q

earliest sign of malignant hyperthermia

A

tachypnea
Tachycardia
Hypertension
Increased end tidal CO2

other findings:
Hyperkalemia
Acidosis

133
Q

mechanisms dantrolene

A

muscle relaxant

Blocks excitation contraction coupling of muscle cells

134
Q

Cantile’s line

A

IVC and gallbladder

135
Q

segments of left liver

A

2
3
4

136
Q

most lateral segments of the left liver

A

2 and 3

137
Q

most posterior segments of right liver

A

6 and 7

138
Q

right shift of oxygen saturation curve

A

the decrease his oxygen affinity
with increase release to tissue

” right his right”

 increased temperature
 increase pCO2
 increased to 2,3-DPG -  helps unload o2
 DECREASED  pH (increase acid)
hypoxia
 carbon monoxide  decreases P50 of hemoglobin
139
Q

left shift of oxygen saturation curve

A

more tightly bound worse for tissue

decrease temperature
Decreased pCO2
Decrease 2,3 DPG
INCREASED pH (decreased acid)

fetal hemoglobin

140
Q

presentation and CT findings of pancreatic lymphoma

A

bulky mass
Surrounding lymphadenopathy
- increased LDH
normal bilirubin

absence:
Weight loss
Extrahepatic biliary obstruction
elevated bilirubin

EUS biopsy confirms

NO surgery for lymphoma

Treatment:
chemotherapy

141
Q

criteria for resection for cure of pancreatic adenocarcinoma

A

Resectable tumors are defined as localized to the pancreas, with no evidence of SMV or portal vein involvement (i.e., no abutment, distortion, thrombus, or encasement) and a preserved fat plane surrounding the SMA and celiac artery branches, including the hepatic artery. Patients with imaging consistent with resectable disease should proceed with operative resection.

only regional lymph nodes are still considered operative management

field of resection, ascites, or vascular involvement beyond the borderline 180 dgr incasement

142
Q

pancreatic adenocarcinoma defines borderline resectable as tumors that exhibit one of the following characteristics:

A

(1) severe unilateral or bilateral SMV-portal impingement; (2) less than 180-degree tumor abutment on the SMA; (3) abutment or encasement of hepatic artery, if reconstructible; and (4) SMV occlusion, if of a short segment, and reconstructible

143
Q

Adjuvant chemo for pancreatic adenocarcinoma

A

Current NCCN guidelines continue to recommend gemcitabine or 5-FU alone, or in combination with 5-FU– based chemoradiation, as adjuvant treatment following resection for PDAC

144
Q

neoadjuvant chemoradiation pancreatic adenocarcinoma

A

no studies have shown an improvement in overall survival for patients who receive neoadjuvant chemotherapy and radiation.

For individuals with significant SMV–portal vein involvement (>180 degrees or short-segment encasement), or hepatic arterial or SMA abutment (<180 degrees) who have been traditionally considered unresectable, neoadjuvant therapy may play an important role in identifying the subset of patients most likely to derive benefit from aggressive multimodality therapy, including surgical resection with vascular reconstruction.[51] This type of aggressive treatment should be undertaken only by an experienced multidisciplinary team in the setting of a clinical trial

145
Q

ASA classification

A

one-normal healthy
2 - mild systemic disease
3-severe systemic disease
4-severe systemic disease that is consistent with threat to life (unstable angina)
5-morbnd patient does not expected to survive without intervention
6-brain-dead

lack of any adjustment and intubation difficulty

146
Q

lab findings of hemophilia A.

A

prolonged PTT

Normal PT and bleeding time

147
Q

Intraoperative choices to administer and bleeding hemophilia A in order of preference

A

cryoprecipitate:

factor 8 and fibrinogen

148
Q

Reed-Sternberg cells

A

associated with lymphoma

149
Q

HeinZ bodies

A

the nature to hemoglobin

150
Q

target cells

A

immature cells the increasing number

151
Q

pappenheimer bodies

A

iron granules seen increasing after splenectomy

152
Q

cell mediated immunity

A

T. cell mediated response
initiate CD4 and CD8 lymphocyte

 pathogens targeted:
Virus
Fungus
protozoans
INTRAcellular bacteria

but not good old fashion bacteria like a Haemophilus influenza

153
Q

indications for emergency discectomy of vertebrae

A

cauda equina syndrome only indication for urgent

154
Q

condition of ovarian torsion

A

initial venous and lymphatic obstruction
Cyanotic edematous ovary

Progresses to low-grade fever and leukocytosis with adnexal necrosis

Doppler

155
Q

Primary common duct stones

A

most common primary bile duct stone composition is calcium bilirubinate

pigmented in colon
Block-excess bilirubin due to hemolysis

Brown-de congregation of bilirubin by bacteria, Escherichia coli precipitates and calcium bilirubinate

156
Q

most common nerve injured and laparoscopic hernia repair

A

Genital femoral

Lateral femoral cutaneous

157
Q

most common nerve injury with open inguinal hernia repair

A

ilioinguinal

Genital branch of general femoral ( careful, most common in laparoscopy is genital femoral)

Iliohypogastric

158
Q

testicular tumor consistent with AFP or beta hCG and LDH elevation

A

nonseminomatous germ cell tumor

159
Q

testicular tumor consistent with beta hCG elevated only

A

10-20% seminoma

careful, AFP never elevated with seminoma

160
Q

management of lower moderate grade dysplasia of Barrett’s

A

endoscopy every 3-6 months

161
Q

rollover fundoplication when Barrett’s is diagnosed

A

if low or moderate:

Fundoplication can stop progression but will not reverse Barrett’s

162
Q

presentation of nasopharyngeal carcinoma

A

ear infections in Caucasian elderly male
with tobacco history

Nasal obstruction

Conductive hearing loss

163
Q

Indications for urgent surgical intervention gunshot wound of the kidney

A

renal pedicle avulsion - life-saving nephrectomy
expanding hematoma
un contained retroperitoneal hematoma
shock

relative indication:
Large amount of devitalized renal parenchyma

does not mandate surgical repair:
Urine extravasation!
most lacerations are to minor calyces and stopped spontaneously

workup for urine extravasation-
Serial CT scan

164
Q

diagnosis of nutcracker esophagus

A

manometry amplitude greater than 180
contraction greater than 6 seconds

normal progressive contraction on esophagram

hyperperistalsis on EGD

165
Q

esophageal pathology with corkscrew esophagus

A

diffuse esophageal spasm

careful, amplitude normal on manometry

166
Q

contraindications ketamine

A

myocardial disease
brain lesion
(Downs ok)

Increase myocardial oxygen consumption

Increased intracranial pressure

167
Q

advantage full-thickness skin graft

A

less contracture

poor take rate

168
Q

advantage split thickness skin graft

A

left vulnerable to shear force

To be placed directly over muscle flap

169
Q

ct finding of pyogenic absces

A

rim enhancing and gas bubbles

170
Q

Uncal herniation early signs

A

cranial nerve III which causes early findings of anisocoria, ptosis, impaired extraocular movements, and sluggish pupillary light reflex on the ipsilateral side of the lesion. Initially

171
Q

Cervical cancer with nodal spread tx

A

Stage IIIB lesion with a poor prognosi

(Advanced stage tumors are defined as IIB-IVA)

Radiation therapy and chemotherapy, not surgery, are the primary treatment modality for advanced cervical cancer.

172
Q

physiologic leukocytosis of pregnancy, which may be as high as

A

16,000 cells/mm3.

173
Q

what his more common in the small bowel primary tumor or metastatic tumor

A

metastatic

Most common met melanoma

174
Q

list cancer that metastasized to small bowel

A

melanoma #1 extra-abdominal source

 intra-abdominal sources more common overall:
Cervix
Ovaries
Kidneys
Stomach
Colon
Pancreas
175
Q

mechanism of amiodarone

A

in addition of the breakdown of cyclic AMP
phosphodiesterase inhibitor

INCREASE his calcium uptake-increased contractility

also vasodilator

176
Q

most common cause of bleeding from pelvic fracture and zone 3 hematoma

A

sacroiliac joint associated arterial bleeding

Usually branch of the internal iliac artery

177
Q

embolized for pelvic bleed with fracture

A

The incidence of arterial hemorrhage amenable to embolization is approximately 10%. In these cases, arteriography with embolization can be lifesaving.

disruption of the sacroiliac (SI) joint, female gender, and duration of hypotension were all predictors of a positive angiogram

178
Q

T. stage colon cancer

A 
1 invasive submucosa
2 today's muscularis propria
3 through muscularis propria and into  pericolic rectal tissue
4a to surface of visceral peritoneum the
4b   invades visceroperitoneum
179
Q

n-stage colorectal adenocarcinoma

A

N1 1-3 regional nodes

N1a  one regional node
N1b 2-3  regional nodes
N1c  without regional nodes:
 but with:
 deposits in the subserosa, mesentery, non-peritonealized pericolic or perirectal tissue

N2a 4-6 nodes
N2b 7 or greater

180
Q

pancreatic divisum

A

failure of fusion of the ventral and dorsal pancreatic ducts

usually asymptomatic

treated with ERCP and sphincteroplasty with sten

duct of Wirsung still drained via major papilla:
drains uncinate process and part of pancreas head

Duct of Santorini:
still draining to be a lesser papilla
drains head, body, tail

diagnoses ERCP

181
Q

primary pulmonary hypertension

A

idiopathic

Aggressive and often fatal

182
Q

duodenal atresia

A

double bubble

Down’s syndrome, maternal polyhydramnios, malrotation, annular pancreas, biliary atresia, cardiac, esophageal, renal, anorectal
VACTRL

distal to anterior levator-biliary emesis

Its distal areas still seen after double bubble need upper GI contrast exclude midgut volvulus

treatment:
Duodenal duodenostomy
either side to side or transverse to distal longitudinal diamond-shaped

183
Q

went blood work findings are seen with complete asplenia

A

Howell-Jolly bodies - no more spleen to filter is out

184
Q

work up for accessory spleen postsplenectomy

A

Howell-Jolly bodies - no more spleen to filter is out

radionucleotide image 2 located accessory spleen

185
Q

best test for pheochromocytoma

A

For pheochromocytoma, the most sensitive markers are serum metanephrines and normetanephrines, which are the breakdown products of circulating catecholamines. If the serum metanephrines are twice the normal level or higher, the patient has a pheochromocytoma;

Do not make the mistake of ordering serum catecholamines, as their rapid fluctuations render them useless. If the result of the serum metanephrines leaves the diagnosis in doubt, a 24 hour urine collection for metanephrines, catecholamines, and vanillylmandelic acid should be ordered. While the sensitivity of this test remains above 95%, it also has better than 95% specificity.

186
Q

choledochocyst type I

A

fusiform dilation common bile duct

Most common

Cholecystectomy and hepatico J.

187
Q

choledochocyst type II

A

EXTRA hepatic
diverticular cyst

Cholecystectomy and hepatico J.

188
Q

choledochocyst type III

A

Distal to common bile duct - Junction with duodenum

cholecystectomy
Resection
Choledochoduodenostomy

189
Q

choledochocyst type IV

A

BOTH intrahepatic and extrahepatic

May require liver resection of involved segment

190
Q

choledochocyst type V

A

INTRA-hepatic

May be to liver failure - In which case transplant is treatment

191
Q

refractory hypertension 6 months post renal transplant

A

transplant renal artery stenosis

workup may include:
Color Doppler ultrasound
MR angiography ( Better than CT)
spiral CT

treatment:
Percutaneous transluminal angioplasty

192
Q

most common type of hip dislocation

A

Posterior dislocations compose 70-80% of all hip dislocations and 90% of all sports-related hip dislocations.

193
Q

most common type of shoulder dislocation

A

ANTERIOR

he clinical presentation of anterior hip dislocation is characterized by abduction and external rotation. Anterior dislocation of the hip, although less common, is more frequently associated with fracture of the femoral head or indentation deformation. Large femoral head fractures and those associated with acetabular or femoral neck fractures have a high incidence of avascular necrosis and hip arthritis

Posterior dislocations compose 70-80% of all hip dislocations and 90% of all sports-related hip dislocations.

194
Q

Posterior hip dislocations

A

Posterior hip dislocations are much more common than anterior dislocations

classically present with an adducted, flexed, and internally rotated extremity (choice A).

195
Q

stimulate the LES

A

Alpha-adrenergic neurotransmitters or beta-blockers stimulate the LES,

gastrin and motilin

196
Q

stimulants decrease in pressure of LES

A

alpha blockers and beta stimulants decrease its pressure.

cholecystokinin, estrogen, glucagon, progesterone, somatostatin, and secretin decrease LES pressure

197
Q

when vecuronium elim decreased

A

renal or hepatic dysfunction

198
Q

what effects Cisatracurium elim

A

Hoggman elimination
also seen with atracurium

good choices if the patient has hepatic or renal failure

199
Q

requirements for endovascular aneurysm repair

A

aortic neck length greater than 1.5 cm
Neck angulation less than 60°
landing zone greater than 1 cm

200
Q

type I endoleak

A

around graft at proximal or distal attachment

201
Q

Type II endoleak

A

Retrograde collateral branch

Lumbar, testicular, inferior mesenteric

202
Q

Type III endoleak

A

Between different parts of components

203
Q

Type IV endoleak

A

2 graft wall

204
Q

Type V endoleak

A

Unknown origin

205
Q

Breslow stage

A

this is the pure depth in millimeters stage

stronger predictor of outcome and Clark’s

Products probability of lymph node involvement and five-year survival

206
Q

treatment of stage III colon adenocarcinoma

A

Stage III colon cancers benefit from adjuvant chemotherapy. Following resection, the recommended chemotherapy regimen is with 5-FU, Leucovorin, and Oxaliplatin. This is known as the FOLFOX therapy, and has shown to increase survival in patients with Stage III colon cancer.

207
Q

chest tube output and hemothorax that mandates operative intervention

A

greater than 1500 mL Initial

Persistent drainage of 200-100 mL per hour for 4 hours after initial drainage

208
Q

what is the plasma carrier of cholesterol

A

LDL

209
Q

diagnosis of solitary lung mass with popcorn calcification

A

hamartoma

Benign

210
Q

Workup for suspected hemobilia

A

first endoscopy - Rules out other sources

angioma and embolectomy definitive

most minor hemobilia is managed conservatively

211
Q

what is most potent hormone to stimulates pancreatic enzyme secretion

A

CCK

stimulated by a release of fatty acid and polypeptide and duodenum

212
Q

normal location for anal fissure

A

posterior

lateral need workup for Crohn’s or STI

213
Q

diseases that splenectomy cure

A

hereditary cytosis
NON-Hodgkin’s lymphoma
CLL with symptomatic splenomegaly

214
Q

C-peptide finding with insulinoma

A

high

C-peptide is endogenous

215
Q

mechanism of aldosterone

A

increase sodium retention and distal tubule

stimulated by angiotensin II the

216
Q

mechanism of angiotensin II

A

convert angiotensin I to angiotensin II didn’t stimulate release of aldosterone

217
Q

mechanism of Renin

A

convert angiotensin edge and angiotensin I

stimulated by low-sodium and distal convoluted tubule, hyperkalemia, hypovolemia

218
Q

diagnosis during laparoscopy sudden decrease in end-tidal CO2 and hypotension

A

CO2 embolus

219
Q

management of familial hypercalcemia hypocalciuria

A

no treatment indicated

hypercalcemia usually mild

220
Q

defects associated with maternal polyhydramnios

A

tracheoesophageal fistula

Duodenal atresia

221
Q

mechanism of jejunal atresia

A

intrauterine mesenteric vascular accident

222
Q

mechanism of gastroischesis

A

failed obliteration of umbilical vein

223
Q

medications contraindicated in obstructive hypertrophy cardiomyopathy

A

dopamine #1 no no

inotrope causes further decreasing cardiac filling and worsens ventricular outflow tract obstruction

224
Q

medications for obstructive hypertrophy cardiomyopathy

A

beta blocker - metoprolol first line
calcium channel blocker

slow down and relax heart to improve filling

amiodarone helps decrease arrhythmia potential

225
Q

risk factors a squamous cell carcinoma head and neck

A

Tobacco
Alcohol
HPV
Epstein-Barr virus

226
Q

immune functions IgA

A

intestinal tract

Produced by plasma cell

Findings antigen
Negative bacteria
Prevent colonization
Neutralize his toxin
Works against  virus

DOES NOT work with optimization

QBANK MIX (28 decks)

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