MIX 5 QBANK Flashcards
Erythropoietin adult versus fetal source
stimulation
Mechanism
Side effects
adult kidney
Fetal liver
stimulation:
Hypoxia
asked on bone marrow
side effects:
Hypertension
Hypercoagulable
success rate of hydrostatic intussusception reduction and recurrence
80%
10%-usually within 24 hours
diagnosis intussusception
physical exam plain film
If diagnosis in question ultrasound
the most common site of intussusception in kids
ileocecal lymphadenopathy
number of recurrences before surgery for intussusception and kids
2 or more
advantages carotid artery stenting versus open carotid endarterectomy
CAS more beneficial with better outcmes when:
asymptomatic
recurrent carotid stenosis
history of neck irradiation.
with severe medical comorbidities, such as three-vessel coronary artery disease
chronic obstructive pulmonary disease (COPD)
disadvantages of stent:
significantly higher stroke rate in the CAS arm of the study
risk of restenosis higher with stent
management of asymptomatic 50-69% stenosis in patient with multiple vessel disease and needs CABG
CABG only
when is polypectomy is sufficient and what his followup
even malignant polyps invasion limited to head or neck
Repeat colonoscopy 3 years
when he is segmental resection needed with polyp characteristics of the bowel
greater than 3 cm Sessile Lymphovascular invasion Invasion into stalk Poorly differentiated Margin less than 2 mm
what are considered germ cell tumors of the testicle
seminoma and non-seminoma
“non-germcell”:Leydig cel, Sertoli cell, gonadoblastoma
management of solid mass seen on ultrasound and the testicle
ALL patient’s get:
Inguinal radical orchiectomy
with CT study for staging
retroperitoneal and lung
most common sites of testicular cancer metastasis left versus right
left= periaortic
right= Intra-aortocaval nodes
most significant indicator for malignant potential of GIST of small bowel
greater than 5 mitoses per high power field
greater than 5 cm
findings with VIPoma
WDHA
watery diarrhea
hypokalemia
Achlorhydria
metabolic acidosis-careful, no chloride - but lost bicarbonate from diarrhea
distal pancreas
Workup for VIPoma
VIP May need to be measured multiple times and serum
EUS is most sensitive
CT scan localizes most
symptom management of VIPoma
octreotide and can help with diarrhea and lytes
palliative debulking can sometimes improve symptoms
or pancreatic endocrine tumor is associated with diabetes
glucagonoma
AND
Somatostatinoma
and appeared treatment with mucopurulent cervicitis
chlamydia
gonorrhea
Treatment of trichomonas and bacterial vaginosis should be reserved for when these diseases are detected
Signs of adrenal insufficiency
hyperpigmentation - a PTH induced Hypotension Hyponatremia HYPERkalemia weight loss nausea vomiting abdominal pain weakness
most potent stimulator of bile secretion
CCK- Stimulates pancreatic enzyme secretion Stimulates gallbladder contraction Relaxes sphincter of Oddi Inhibits gastric emptying
Cholecystokinin (CCK), secreted by the intestinal mucosa, serves to induce biliary tree secretion and gallbladder wall contraction, thereby augmenting excretion of bile into the intestines.
secretin
Stimulates release of water and bicarbonate from pancreatic ductal cells
Stimulates flow and alkalinity of bile
Inhibits gastric acid secretion and motility and inhibits gastrin release
T stage for hepatocellular carcinoma
T1-no vascular invasion any size, solitary
T2-solitary tumor any size with vascular invasion
or
multiple tumors all less than 5 cm
T3-multiple tumors greater than 5 cm
or
invasion in the major branch of portal or hepatic veins
T4-invasion into organs - or perforates visceral peritoneum
BUT the gallbladder does not count
with anatomic artery variance can come directly off of the innominate artery
thyroid ima -
which can supply both medial aspects of both lobes of the thyroid
ligamentum arteriosum anatomy
superior surface of the pulmonary artery and the inferior surface of the aortic arch. It is a nonfunctional vestige of the ductus arteriosus, and is formed within three weeks of birth.
left recurrent laryngeal nerve, a branch of the left vagus nerve.
absolute contraindications to laparoscopic splenectomy for ITP
cirrhosis
Pregnancy
poor cardiopulmonary status
Splenomegaly is not a contraindication
to most common malignant tumor of the parotid gland
mucoepidermoid carcinoma
management of mucoepidermoid carcinoma parotid gland
high-grade:
Highly aggressive
Total parotidectomy
RADICAL neck dissection
Postop radiation therapy regardless of nodes
prepared for an extended, radical parotidectomy, which may involve resection of overlying skin, adjacent mandible and soft tissue, temporal bone, and a portion of the adjacent external ear. With advanced presentations, the facial nerve is invariably sacrificed in these patients; free tissue transfer may be necessary for repair.
most common malignancy of the submandibular gland
adenoid cystic carcinoma
(parotid a second most common site)
high rate of perineural invasion
Treatment of adenoid cystic carcinoma
most common site submandibular gland
Perineural spread,
Treatment:
Radical resection
Sacrificing nerves only for direct tumor extension
Postoperative radiation
most common benign lesion of major salivary glands
pleomorphic adenoma
the may have pseudopods extension beyond apparent borders of mass-high recurrence but not necessarily malignant transformation
Treatment of pleomorphic adenoma
Resection of tumor within a margin of normal gland surrounding it
Superficial parotidectomy classic treatment
Findings the facial nerve identified and preserved at with complete tumor extirpation
Warthin’s tumor
tail of parotid typically benign cystic Multicentric Temperature bilateral
Treatment:
Superficial parotidectomy-somewhat a pleomorphic adenoma
Indications for radical neck dissection
all high grade malignant tumors or parotid gland
(Even with negative nodes on exam)
Squamous cell carcinoma of the prostate gland
were present volume of blood can be lost in pregnant female before showing signs of shock
35%
normal cardiac index
2.5-4.5
normal the stomach vascular resistence
1000 -1500
trend and pulmonary artery catheterization with cardiac tamponade
equalization and diastolic pressures
first abnormality usually seen in MEN 1
hypercalcemia
her most common pancreas tumor overall in MEN1
to nonfunctional pancreatic neuroendocrine tumor or secretin pancreatic polypeptide
most common functional neuroendocrine tumor is gastrinoma
signs of Zollinger-Ellison syndrome
GERD
Circuitry diarrhea
Weight loss
pancreas pathology associated with lymphoplasmacytic infiltration
chronic autoimmune pancreatitis
Volkmann’s contracture
associated with
splinting in acute flexion occludes neurovascular structures ( brachial artery the supracondylar)
Compartment syndrome-fibrosis
origin and course of the right coronary artery
right coronary sinus
anterior surface of heart
In atrioventricular groove
supplies right ventricle
branches the right coronary artery
90%:
Posterior descending artery
Right posterior lateral artery
this pattern is right dominant
90%:
Branches to AV node
50%:
Branches to S-A node
most common origin of coronary circumflex artery
right coronary artery
seborrheic keratosis as a risk factor for what
nothing
skin lesion that is risk factor for squamous cell carcinoma
actinic keratosis
(Careful, NOT seborrheic keratosis)
Chronic draining sinus
Burn
scar
with topical burn antibiotics with a sulfa
Silvadene-silver sulfadiazine
mafenide acetate-Sulfamylon
subacute thyroiditis thyroid function findings
none
symptoms of TTP
thrombotic thrombocytopenic purpura FATRN Fever Anemia Thrombocytopenic purpura Renal failure Neuro-mental status
medical treatment of TTP
anti platelet-aspirin dipyridamole
FFP can be helpful
Plasmapheresis
Corticosteroid
splenectomy for TTP
failed medical management
Decrease mortality long-term
Salivary gland tumors treated with superficial parotidectomy
Warthin’s tumor
Pleomorphic adenoma ( unless malignant)
treatment of SIADH with small stable intracranial hemorrhage
fluid restriction
laboratory findings of SIADH
hyponatremia
LOW serum osmolality
HIGH urine osmolality
treatment of stress incontinence with decrease bladder contraction
intermittent self catheter
NOT cholinergic - Urecholine
management of diverticular abscess percutaneous drainage not available
laparoscopic drainage
other symptoms with thoracic aortic aneurysm
Compressive:
hoarseness
Dyspnea
Early satiety
newborn presents with severe respiratory distress hyperlucency left thorax, chest tube causes further decompensation diagnosis and treatment
congenital lobar emphysema
Immediate thoracotomy and lobectomy
mistaken for pneumothorax with an appropriate chest tube placement
Positive pressure ventilation contraindicated
If asymptomatic can observe
Difference between mean in median
mean of the average: data points added then divided by a number of data points
median is that either lives in the center of the data points when there are arranged and numerical order - also known as 50th percentile
effect of PTH and vitamin D
PTH increases renal synthesis of calcitriol - the hormonally active form of vitamin D
this increases intestinal obstruction of calcium
effect of PTH on phosphorus
blocks reabsorption and proximal and distal tubules
diagnosis of cholangiocarcinoma
Adenocarcinoma of the bile ducts
ultrasound for intrahepatic
MRI for extrahepatic
cameron and says no invasive cholangiogram
A chest radiograph is sufficient evaluation for pulmonary metastases. The role of PET/CT was discussed previously; judicious use is reasonable based on the current data
In a healthy patient with resectable disease and a total bilirubin less than 10 mg/dL, ideal treatment would be resection without any biliary intervention. .
treatment of cholangiocarcinoma
complete resection, which typically requires en bloc hepatectomy. Thus, resection is appropriate for medically fit patients without extrabiliary disease.
The presence of metastases, either intrahepatic or within regional lymph nodes outside the hepatoduodenal ligament, is a contraindication to resection
nvolvement of the distal common bile duct margin necessitates the addition of a pancreaticoduodenectomy. A Roux-en-Y hepaticojejunostomy brought into the right upper quadrant through a retrocolic mesenteric defect allows restoration of bilioenteric continuity.
presentation a blind loop syndrome
Crohn’s patient with obstruction
Steatorrhea, diarrhea, megaloblastic anemia, and malnutrition are the hallmarks of blind loop syndrome.
treatment of cystadenoma of the appendix
appendectomy alone - do not biopsy because risks rupture which can cause pseudomyxoma peritonei
careful, this is DIFFERENT from cystadenocarcinoma - that is treated with right hemicolectomy
causes of pancreatic ascites
pancreatic duct disruption
Leaking pseudocyst
Treatment of pancreatic ascites
Initial colon
N.p.o., nasogastric drainage, somatostatin
Possible paracentesis
50% respond to conservative management 2-3 weeks
persistent:
ERCP demonstrated site of duct disruption
Resection if in tail
Or
Roux-en-Y drainage for leaks and head and neck
NOT stent
pancreaticopleural fistula
Dr. disruption usually posterior
Careful, pancreatic juice traveled cephalad through retroperitoneum to reach thorax
the management of arrhythmia is persistent despite pulling pulmonary catheter back
lidocaine were other antiarrhythmic
detail and plane film the esophageal atresia does not also have tracheoesophageal fistula
tracheoesophageal fistula who present with air and the intestine
where it is peripheral artery disease developed in smoking and atherosclerosis
proximal vessels
melanoma with worst prognosis
nodular
Aggressive vertical phase
Early distant metastases
contraindication to Arixtra
renal failure
Primarily excreted by kidneys
absolute indications for IVC filter
thromboembolic disease with a contraindication to anticoagulation or complication or failure of anticoagulation
management of ischemic orchitis after inguinal hernia repair postop day 5
nonsteroidal anti-inflammatory
Causes venous congestion from pampiniform plexus and thrombosis
Possible ligation of testicular artery during repair
Present days 2-5 postop
minimize his risk of ischemic orchitis with inguinal hernia repair
excessive dissection of spermatic cord
at the tumor marker for granulosa cell ovarian cancer
“Inhibin” ( may be falsely positive in premenopausal)
careful, CA 125 - his marker for girdle fashion epithelial ovarian cancer
Indications for ED thoracotomy
penetrating chest trauma
the signs of life in the field
witnessed loss of pulses
signs of life:
Ventilation Carotid pulse Measurable blood pressure Extremity movement - Not DTRs pupillary reactivity Cardiac electrical activity
thoracic penetrating trauma with best survival rate with ED thoracotomy
cardiac
principle type of collagen in the skin and bone
type I
inflammatory phase of wound healing
separate from proliferative phase
increased vascular permeability
Migration of cells by chemotherapy
Secretions sided times and growth factors
Activation of migraine cells
principal event of proliferative days
collagen deposition
cross-linking occurs
provides tensile strength
formation of granulation tissue
complication risk with EBV after transplant
post transplant lymphoproliferative disease
consultation risk of HHV-8 post transplant
Kaposi’s sarcoma
indications for tetanus
tetanus prone wound: Gross devitalized tissue Obvious contamination Frostbite Missile injury Injury over 6 hours old
Do not require tetanus toxoid if:
any night within past 5 years
Received 3 or more doses of toxoid
Requires tetanus immunoglobulin:
Tetanus prone
Immune status is partial or UNKNOWN
most common bacteria isolated from perforated appendicitis
Escherichia coli
Bacteroides fragilis
what his time. When remodeling phase of wound healing begins - and what take place
last stage
III weeks
Last up to 1 year
converts type III collagen to type I collagen
with mechanism of small cell lung cancer causing Cushing’s syndrome
ACTH
does not suppressed with dexamethasone
upper chest causes of Cushing syndrome
neuroendocrine tumor
Or
Bronchogenic malignancy
most common site of injury to the biliary system during cholecystectomy
CBD
RIGHT hepatic duct
pathophysiology on the in-line level of acute pancreatitis
injury begins in a Acinar cells
intraosseous muscle activation of colon
zymogens
Including trypsinogen
Cathepsin-B can activate zymogens
blood supply of hepatic metastases
hepatic artery
advantage of chemotherapy embolization of her systemic chemotherapy
better response
Lower side effect
Extraction rate 90%
High local concentration
This is adjuvant therapy does not resulting cure
at its beta hCG threshold to determine intrauterine pregnancy
1500 - 2000
diagnosis of ectopic pregnancy
empty uterus
Beta-hCG higher than 1500
this may also be seen with early pregnancy
define Culdocentesis
Fluid sampled from cul-de-sac of Douglas
test rarely performed to assess bleeding
Cullen’s sign
can be seen an ectopic pregnancy
superficial edema and bruising and subcutaneous fatty tissue around the umbilicus
candidate for medical management of ectopic pregnancy
not ruptured - Ruptured is emergent operation
beta-hCG less than 15,000
fetus less than 3.5 cm
compliant patient
No intrauterine pregnancy
