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QBANK MIX > MIX 5 QBANK > Flashcards

MIX 5 QBANK Flashcards

1
Q

Erythropoietin adult versus fetal source
stimulation
Mechanism
Side effects

A

adult kidney
Fetal liver

stimulation:
Hypoxia

asked on bone marrow

side effects:
Hypertension
Hypercoagulable

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2
Q

success rate of hydrostatic intussusception reduction and recurrence

A

80%

10%-usually within 24 hours

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3
Q

diagnosis intussusception

A

physical exam plain film

If diagnosis in question ultrasound

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4
Q

the most common site of intussusception in kids

A

ileocecal lymphadenopathy

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5
Q

number of recurrences before surgery for intussusception and kids

A

2 or more

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6
Q

advantages carotid artery stenting versus open carotid endarterectomy

A

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

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7
Q

management of asymptomatic 50-69% stenosis in patient with multiple vessel disease and needs CABG

A

CABG only

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8
Q

when is polypectomy is sufficient and what his followup

A

even malignant polyps invasion limited to head or neck

Repeat colonoscopy 3 years

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9
Q

when he is segmental resection needed with polyp characteristics of the bowel

A 
greater than 3 cm
Sessile
Lymphovascular invasion
Invasion into stalk
Poorly differentiated
Margin less than 2 mm
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10
Q

what are considered germ cell tumors of the testicle

A

seminoma and non-seminoma

“non-germcell”:Leydig cel, Sertoli cell, gonadoblastoma

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11
Q

management of solid mass seen on ultrasound and the testicle

A

ALL patient’s get:
Inguinal radical orchiectomy

with CT study for staging
retroperitoneal and lung

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12
Q

most common sites of testicular cancer metastasis left versus right

A

left= periaortic

right= Intra-aortocaval nodes

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13
Q

most significant indicator for malignant potential of GIST of small bowel

A

greater than 5 mitoses per high power field

greater than 5 cm

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14
Q

findings with VIPoma

A

WDHA
watery diarrhea
hypokalemia
Achlorhydria

metabolic acidosis-careful, no chloride - but lost bicarbonate from diarrhea

distal pancreas

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15
Q

Workup for VIPoma

A

VIP May need to be measured multiple times and serum

EUS is most sensitive

CT scan localizes most

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16
Q

symptom management of VIPoma

A

octreotide and can help with diarrhea and lytes

palliative debulking can sometimes improve symptoms

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17
Q

or pancreatic endocrine tumor is associated with diabetes

A

glucagonoma
AND
Somatostatinoma

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18
Q

and appeared treatment with mucopurulent cervicitis

A

chlamydia
gonorrhea

Treatment of trichomonas and bacterial vaginosis should be reserved for when these diseases are detected

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19
Q

Signs of adrenal insufficiency

A 
hyperpigmentation -  a PTH induced
Hypotension
Hyponatremia
HYPERkalemia
 weight loss
 nausea vomiting
 abdominal pain
 weakness
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20
Q

most potent stimulator of bile secretion

A 
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

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21
Q

T stage for hepatocellular carcinoma

A

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

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22
Q

with anatomic artery variance can come directly off of the innominate artery

A

thyroid ima -

which can supply both medial aspects of both lobes of the thyroid

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23
Q

ligamentum arteriosum anatomy

A

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.

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24
Q

absolute contraindications to laparoscopic splenectomy for ITP

A

cirrhosis
Pregnancy
poor cardiopulmonary status

Splenomegaly is not a contraindication

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25
Q

to most common malignant tumor of the parotid gland

A

mucoepidermoid carcinoma

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26
Q

management of mucoepidermoid carcinoma parotid gland

A

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.

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27
Q

most common malignancy of the submandibular gland

A

adenoid cystic carcinoma

(parotid a second most common site)

high rate of perineural invasion

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28
Q

Treatment of adenoid cystic carcinoma

A

most common site submandibular gland

Perineural spread,

Treatment:
Radical resection
Sacrificing nerves only for direct tumor extension

Postoperative radiation

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29
Q

most common benign lesion of major salivary glands

A

pleomorphic adenoma

the may have pseudopods extension beyond apparent borders of mass-high recurrence but not necessarily malignant transformation

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30
Q

Treatment of pleomorphic adenoma

A

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

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31
Q

Warthin’s tumor

A 
tail of parotid
 typically benign
 cystic
Multicentric
Temperature bilateral

Treatment:
Superficial parotidectomy-somewhat a pleomorphic adenoma

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32
Q

Indications for radical neck dissection

A

all high grade malignant tumors or parotid gland
(Even with negative nodes on exam)

Squamous cell carcinoma of the prostate gland

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33
Q

were present volume of blood can be lost in pregnant female before showing signs of shock

A

35%

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34
Q

normal cardiac index

A

2.5-4.5

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35
Q

normal the stomach vascular resistence

A

1000 -1500

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36
Q

trend and pulmonary artery catheterization with cardiac tamponade

A

equalization and diastolic pressures

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37
Q

first abnormality usually seen in MEN 1

A

hypercalcemia

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38
Q

her most common pancreas tumor overall in MEN1

A

to nonfunctional pancreatic neuroendocrine tumor or secretin pancreatic polypeptide

most common functional neuroendocrine tumor is gastrinoma

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39
Q

signs of Zollinger-Ellison syndrome

A

GERD
Circuitry diarrhea
Weight loss

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40
Q

pancreas pathology associated with lymphoplasmacytic infiltration

A

chronic autoimmune pancreatitis

41
Q

Volkmann’s contracture

A

associated with
splinting in acute flexion occludes neurovascular structures ( brachial artery the supracondylar)
Compartment syndrome-fibrosis

42
Q

origin and course of the right coronary artery

A

right coronary sinus
anterior surface of heart
In atrioventricular groove
supplies right ventricle

43
Q

branches the right coronary artery

A

90%:
Posterior descending artery
Right posterior lateral artery
this pattern is right dominant

90%:
Branches to AV node

50%:
Branches to S-A node

44
Q

most common origin of coronary circumflex artery

A

right coronary artery

45
Q

seborrheic keratosis as a risk factor for what

A

nothing

46
Q

skin lesion that is risk factor for squamous cell carcinoma

A

actinic keratosis
(Careful, NOT seborrheic keratosis)

Chronic draining sinus
Burn
scar

47
Q

with topical burn antibiotics with a sulfa

A

Silvadene-silver sulfadiazine

mafenide acetate-Sulfamylon

48
Q

subacute thyroiditis thyroid function findings

A

none

49
Q

symptoms of TTP

A 
thrombotic thrombocytopenic purpura
FATRN
Fever
Anemia
Thrombocytopenic purpura
Renal failure
Neuro-mental status
50
Q

medical treatment of TTP

A

anti platelet-aspirin dipyridamole
FFP can be helpful
Plasmapheresis
Corticosteroid

51
Q

splenectomy for TTP

A

failed medical management

Decrease mortality long-term

52
Q

Salivary gland tumors treated with superficial parotidectomy

A

Warthin’s tumor

Pleomorphic adenoma ( unless malignant)

53
Q

treatment of SIADH with small stable intracranial hemorrhage

A

fluid restriction

54
Q

laboratory findings of SIADH

A

hyponatremia
LOW serum osmolality
HIGH urine osmolality

55
Q

treatment of stress incontinence with decrease bladder contraction

A

intermittent self catheter

NOT cholinergic - Urecholine

56
Q

management of diverticular abscess percutaneous drainage not available

A

laparoscopic drainage

57
Q

other symptoms with thoracic aortic aneurysm

A

Compressive:
hoarseness
Dyspnea
Early satiety

58
Q

newborn presents with severe respiratory distress hyperlucency left thorax, chest tube causes further decompensation diagnosis and treatment

A

congenital lobar emphysema

Immediate thoracotomy and lobectomy

mistaken for pneumothorax with an appropriate chest tube placement

Positive pressure ventilation contraindicated

If asymptomatic can observe

59
Q

Difference between mean in median

A

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

60
Q

effect of PTH and vitamin D

A

PTH increases renal synthesis of calcitriol - the hormonally active form of vitamin D

this increases intestinal obstruction of calcium

61
Q

effect of PTH on phosphorus

A

blocks reabsorption and proximal and distal tubules

62
Q

diagnosis of cholangiocarcinoma

A

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. .

63
Q

treatment of cholangiocarcinoma

A

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.

64
Q

presentation a blind loop syndrome

A

Crohn’s patient with obstruction

Steatorrhea, diarrhea, megaloblastic anemia, and malnutrition are the hallmarks of blind loop syndrome.

65
Q

treatment of cystadenoma of the appendix

A

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

66
Q

causes of pancreatic ascites

A

pancreatic duct disruption

Leaking pseudocyst

67
Q

Treatment of pancreatic ascites

A

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

68
Q

pancreaticopleural fistula

A

Dr. disruption usually posterior

Careful, pancreatic juice traveled cephalad through retroperitoneum to reach thorax

69
Q

the management of arrhythmia is persistent despite pulling pulmonary catheter back

A

lidocaine were other antiarrhythmic

70
Q

detail and plane film the esophageal atresia does not also have tracheoesophageal fistula

A

tracheoesophageal fistula who present with air and the intestine

71
Q

where it is peripheral artery disease developed in smoking and atherosclerosis

A

proximal vessels

72
Q

melanoma with worst prognosis

A

nodular

Aggressive vertical phase

Early distant metastases

73
Q

contraindication to Arixtra

A

renal failure

Primarily excreted by kidneys

74
Q

absolute indications for IVC filter

A

thromboembolic disease with a contraindication to anticoagulation or complication or failure of anticoagulation

75
Q

management of ischemic orchitis after inguinal hernia repair postop day 5

A

nonsteroidal anti-inflammatory

Causes venous congestion from pampiniform plexus and thrombosis

Possible ligation of testicular artery during repair

Present days 2-5 postop

76
Q

minimize his risk of ischemic orchitis with inguinal hernia repair

A

excessive dissection of spermatic cord

77
Q

at the tumor marker for granulosa cell ovarian cancer

A

“Inhibin” ( may be falsely positive in premenopausal)

careful, CA 125 - his marker for girdle fashion epithelial ovarian cancer

78
Q

Indications for ED thoracotomy

A

penetrating chest trauma
the signs of life in the field
witnessed loss of pulses

79
Q

signs of life:

A 
Ventilation
Carotid pulse
Measurable blood pressure
Extremity movement - Not DTRs
 pupillary reactivity
Cardiac electrical activity
80
Q

thoracic penetrating trauma with best survival rate with ED thoracotomy

A

cardiac

81
Q

principle type of collagen in the skin and bone

A

type I

82
Q

inflammatory phase of wound healing

A

separate from proliferative phase

increased vascular permeability
Migration of cells by chemotherapy
Secretions sided times and growth factors
Activation of migraine cells

83
Q

principal event of proliferative days

A

collagen deposition
cross-linking occurs
provides tensile strength
formation of granulation tissue

84
Q

complication risk with EBV after transplant

A

post transplant lymphoproliferative disease

85
Q

consultation risk of HHV-8 post transplant

A

Kaposi’s sarcoma

86
Q

indications for tetanus

A 
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

87
Q

most common bacteria isolated from perforated appendicitis

A

Escherichia coli

Bacteroides fragilis

88
Q

what his time. When remodeling phase of wound healing begins - and what take place

A

last stage
III weeks
Last up to 1 year

converts type III collagen to type I collagen

89
Q

with mechanism of small cell lung cancer causing Cushing’s syndrome

A

ACTH

does not suppressed with dexamethasone

90
Q

upper chest causes of Cushing syndrome

A

neuroendocrine tumor
Or
Bronchogenic malignancy

91
Q

most common site of injury to the biliary system during cholecystectomy

A

CBD

RIGHT hepatic duct

92
Q

pathophysiology on the in-line level of acute pancreatitis

A

injury begins in a Acinar cells
intraosseous muscle activation of colon
zymogens
Including trypsinogen

Cathepsin-B can activate zymogens

93
Q

blood supply of hepatic metastases

A

hepatic artery

94
Q

advantage of chemotherapy embolization of her systemic chemotherapy

A

better response
Lower side effect
Extraction rate 90%
High local concentration

This is adjuvant therapy does not resulting cure

95
Q

at its beta hCG threshold to determine intrauterine pregnancy

A

1500 - 2000

96
Q

diagnosis of ectopic pregnancy

A

empty uterus
Beta-hCG higher than 1500
this may also be seen with early pregnancy

97
Q

define Culdocentesis

A

Fluid sampled from cul-de-sac of Douglas

test rarely performed to assess bleeding

98
Q

Cullen’s sign

A

can be seen an ectopic pregnancy

superficial edema and bruising and subcutaneous fatty tissue around the umbilicus

99
Q

candidate for medical management of ectopic pregnancy

A

not ruptured - Ruptured is emergent operation

beta-hCG less than 15,000
fetus less than 3.5 cm
compliant patient
No intrauterine pregnancy

QBANK MIX (28 decks)

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