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QBANK MIX > MIX 6 QBANK > Flashcards

MIX 6 QBANK Flashcards

1
Q

findings associated with Crohn’s disease compared ulcerative colitis

A 
rectal sparing
Granulomas
Ulcerations
Seizures
Fistulous
The abscess
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2
Q

differentiate hypertrophic scar versus keloid

A

both itchy

hypertrophic scars:
 developed in 6-8 weeks
 increased density or blood vessels
 increased myofiberblasts
subside with time
 maintained boundaries of original scar
 associated with closing wound under tension
 keloid,
Developed months after injury
  DECREASED density of blood vessels
 NO myofiberblasts
 they do not regress
 grow outside of boundaries
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3
Q

mechanism of calcitonin

A

stimulated by high calcium level

para follicular cells of the THYROID

opposes PTH

increases excretion of phosphorus

inhibit osteoclasts

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4
Q

blood supply of gastric conduit

A

RIGHT is right

gastroepiploic

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5
Q

name trends of immuno drugs

A

inib - inhibitory

mumab = fully human

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6
Q

Hypermagnesemia

A

characterized by loss of deep tendon reflexes, paralysis, coma, hypotension and cardiac arrest. It may follow burn or crush injuries.

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7
Q

Hypokalemia symptoms include

A

paresthesia, weakness and flaccid paralysis. It may progress to cause ventricular fibrillation and cardiac arrest. Causes are numerous and include decreased renal function, ACE inhibitor medications, succinylcholine, and ischemia-reperfusion injury.

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8
Q

Actions and CCK

A 
gallbladder contraction
Sphincter of Odie relaxation
Pancreatic enzyme stimulation
Inhibits gastric emptying
NOT related to bicarbonate

release from duodenum and jejunum
I cells

stimulated by fat, polypeptide, amino acid

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9
Q

causes of torsades de pointes

A

prolonged QT interval 500 msec or longer
hypokalemia
hypomagnesemia
renal failure

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10
Q

treatment of torsades the points

A

correct electrolytes

Increased heart rate - This shortened the ventricular repolarization

Magnesium sulfate

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11
Q

T-cell mediated rejection of the liver transplant

A

Most common time of presentation his first 10 days

30-50% within the first 6 months

treatment is increasing immunosuppression

unlike renal transplant does not affect overall graft survival!

Pathology findings:
Leukocytosis, eosinophilia, malaise

biopsy:
Portal leukocytosis, and ileitis, bile duct infiltration and damage

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12
Q

findings seen on chronic rejection of liver

A

increased total bilirubin
Increased alkaline phosphatase

Vanishing bile duct syndrome

Lymphocytic direct attacks on biliary ducts

No treatment except retransplantation

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13
Q

Treatment of post liver transplant biliary leak

A

a initial management nonoperative:

ERCP and stent

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14
Q

treatment of Graves disease possible complications

A

radioactive iodine

may make proptosis worse

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15
Q

vagus nerve innervated

A 
epiglottis
The larynx 
 trachea
Bronchi
 lung
Esophagus
 heart
Stomach
 mesentery
Bowel
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16
Q

workup for suspected blunt cardiac injury

A

admission and followup in our EKG on suspected

admission EKG normal:
workup can be terminated

to have normal colon
Cardiac monitoring 24-48 hours

If unstable hemodynamic:
Echo - 2 transthoracic first batch is suboptimal, transesophageal

sternal fracture does not mandate continuous monitoring and EKG is normal - but if present and may suspect blunt cardiac injury and requires admission EKG

Troponin and CPK-MB not helpful

to her her to the

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17
Q

recommendations for treatment of C. difficile

A

mild to moderate:
Flagyl

recurrent:
Flagyl

severe case:
Vancomycin

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18
Q

management of hepatic artery aneurysm

A

require intervention:
2 cm or greater
Rupture
Symptomatic

Common hepatic artery aneurysm:
Ligation or embolization only
ONLY bypass if:
 Whipple ( no GDA)
 no ligation if:
 cirrhosis-ischemic compromise and encephalopathy

proper hepatic artery:
Requires bypass - GDA is proximal to this lesion

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19
Q

Reduction maneuver for posterior hip dislocation

A

opposite of defect:
Traction
Abduction
external rotation

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20
Q

associated injury with posterior hip dislocation

A

sciatic nerve
Femoral nerve
Obturator nerve ( careful, don’t confuse the obturator artery)
with

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21
Q

supracondylar fracture of the humerus associated injury

A

brachial artery

Volkmann’s contracture

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22
Q

distal radius associated injury

A

median nerve compression

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23
Q

anterior dislocation the shoulder associated injury

A

axillary nerve injury

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24
Q

histologic depth of deep second-degree burn

A

reticular dermis

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25
Q

weighted criteria for fistulotomy with intersphincteric fistula

A

minimally involvement of the external anal sphincter

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26
Q

when is a seton indicated

A

transsphincteric fistula

presumably involved external sphincter

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27
Q

initial management of transposition of the great vessels

A

keep PDA open:
PGE1 (prostaglandin)

This provided left to right shunt and improve symptoms

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28
Q

Definitive management of transposition of the great vessels

A

balloon atrial septoplasty percutaneously through umbilical or femoral vein

allows atrial mixing

Then discontinue prostaglandin

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29
Q

common associated injury with trauma splenectomy

A

pancreatic tail injury

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30
Q

plasma free metanephrine test

A

Pheochromocytoma

High sensitivity: 99%
Lower specificity: 85%
( rules out patient's one positive because positive is positive)
 but if negative, still unsure:
 so need a 24-hour urine
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31
Q

24-hour urine metanephrine test

A

very high specificity and sensitivity

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32
Q

which imaging studies better to study anatomy of pheochromocytoma

A

CT is better than MRI!

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33
Q

Given example ordinal data

A

tumor stage

inherent order but interval between stages may vary

considered qualitative

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34
Q

measures of central tendency

A

mean, median, mode

titrated for continuous data

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35
Q

what type of data as needed for student t teest

A

continuous data

Measures and central tendency

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36
Q

What type of days need for Chi-square test

A

binary

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37
Q

what is responsible for wound contraction

A

myo fibroblasts

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38
Q

was responsible for collagen production

A

fibroblasts

39
Q

diagnosis and treatment algorithm for effort induced venous thrombosis

A

duplex ultrasound

if acute presentation:
Venogram basilic vein document extensive thrombus begin thrombolysis

heparinized also administered..

for followup venogram to confirm persistent thrombus

First rib resection for decompression

40
Q

when the sentinel lymph node biopsy indicated for melanoma

A

clinically negative nodes because if positive will do lymph node dissection

Tumor thickness created 1 mm

or tumor thickness was less than 1 mm when:
Ulceration
Regression
Greater than 1 mitoses per 10 high-power field

Clark’s level IV and V

41
Q

what is at level III axillary node dissection landmark

A

medial to pectoralis minor

42
Q

normal physiologic trigger to release secretin

A

acid and duodenum

43
Q

functions secretin

A

increase bicarbonate release from pancreas

This neutralized with acid chyme

Inhibits:
 gastric release
Acid secretion
Gastric motility
( goals of digestion and mixing)
44
Q

what is considered a positive separate and stimulation test

A

increase in serum gastrin greater than 200 above basal level

45
Q

In the rare case that surgery is performed for Ogilvie syndrome what is approach

A

usually cecostomy for external decompression

rectal tube is ineffective

46
Q

laboratory determination of ARDS and requirements

A

PaO2/FiO2: LESS than 200

and exclusion of cardiogenic pulmonary edema must be possible

47
Q

Swan-Ganz pulmonary artery wedge pressure that would rule out cardiogenic pulmonary edema

A

less than 18

48
Q

best test to evaluate history of vomiting epigastric abdominal pain without peritonitis or vital sign concerns

A

Boerhaave syndrome

Gastrografin esophagram

If negative colon
Endoscopy to definitively rule out perforation

49
Q

describe rapid sequence intubation in order

A

preoxygenated - 3 minutes ( to 8 minutes before apnea and de saturation less than 90%)
Fentanyl - protects with cardiovascular disease from catecholamine surge and
Etomidate
Succinylcholine
Extension

50
Q

list the renal hilum structures from anterior to posterior

A

renal vein
Renal artery
Ureter/renal pelvis

51
Q

Adson test for thoracic outlet syndrome

A

also called scalene test

neck extension turned head towards the ipsilateral effected extremity

Ipsilateral radial pulse disappears when positive

52
Q

antibiotic of choice with PID abscess

A

clindamycin penetrates abscess

Also add aminoglycoside

53
Q

treatment of GIST

A

1- 2 cm margin
Wedge resection adequate
Did not need node resection

Adjuvant Gleevac:
3 cm or greater
5 or greater mitoses per 50 high-power field

unresectable:
Gleevac

54
Q

indications for neoadjuvant Gleevac

A

possibly unresectable tumors or large tumors
extensive organ involvement
Duodenal
rectal
near the gastric esophageal junction and the

55
Q

greatest risk factor for GIST malignancy

A

risk factors for malignancy are tumor size larger than 10 cm and more than five mitoses/50 HPF.

56
Q

followup after GIST excision and treatment

A

post excision
CT scan every 3-6 months for the first 5 years!
then annual

This is for tumors probably greater than 2 cm

57
Q

management of GIST recurrent

A

surgeries better

Gleevec usually has maximal response by 2-6 months

58
Q

management of penetrating chest injury with acute cardiac tympanod unstable

A

left thoracotomy ED

59
Q

primary actions of calcitonin

A

decrease PTH

Decrease phosphorus level because of renal excretion is increased

60
Q

wet portion of the colon has the greatest absorption

A

proximal colon
needle water fast
over 1 L a day

61
Q

most common malignancy of the appendix

A

adenocarcinoma

careful, most common tumor of the appendix as carcinoid-not all carcinoid or malignant

62
Q

mucinous cystadenoma of the appendix benign or malignant

A

benign

63
Q

cancer that can metastasize to the appendix

A

breast cancer
Colon cancer
General tract

64
Q

Treatment of hepatorenal syndrome

A

because of cirrhosis, hypervolemia is associated with intravascular DECREASED fluid

treatment fluid

can improve after liver transplant

65
Q

what lobes at the oblique fissure separate

A

middle from lower

66
Q

way lobes of the minor fissure separate

A

upper from middle

67
Q

ratio of bile salts, cholesterol, phospholipid lecithin associated with gallstone

A

to high value constituents can be seen with one low value constituent informed stones

cholesterol component is dependent on either substances can be low stones

high bile salt and high possible lipid with a low-cholesterol can cause gallstones

68
Q

symptoms of hyponatremia

A

confusion 2 seizure

Muscle fatigue or cramps

Nausea vomiting

69
Q

hypercalcemia symptoms and associations

A

nausea vomiting
Diarrhea

Weakness confusion

Psychoses
Kidney stones

 associated:
Prolonged immobilization
Granulomatous disease
Dyazide
Malignancy
Hyperparathyroidism
70
Q

hypermagnesemia symptoms and associations

A

LOSS of deep tendon reflex

Paralysis

Coma

HYPO-tension

Cardiac arrest

Association colon
Burn
Crush

71
Q

what needs to be monitored when getting thrombolytic

A

fibrinogen level

TPA causes hypofibrinogenemia

72
Q

r disseminated intravascular coagulation relationship to thrombin

A

excess thrombin: Marker of this is split products were d-dimer

73
Q

mechanism of refeeding syndrome and presentation with laboratory findings

A

rapid substrate to chronically depleted system overwhelmed ATP metabolism

Decrease:
phosphorus
Potassium
Magnesium

 symptoms:
Nausea vomiting
Weakness With the muscle spasticity
Technique
Cardiac arrhythmias including arrest after ectopy
74
Q

Treatment of refeeding syndrome

A

decreased calories especially glucose

Replace electrolytes - which will not work and that she decrease calories

75
Q

absolute contraindication to thrombolytics

A 
active internal bleeding
Within 2 months of:
Cerebrovascular accident
 intracranial surgery
Spinal surgery
Intracranial neoplasm
Uncontrolled hypertension severe
Uncontrollable clotting disorder
Previous allergy
76
Q

Relative contraindications to thrombolytic

A 
within 10 days of:
Operation or obstetrical
Procedure site that is noncompressible (example, gastrointestinal, cardiopulmonary, possibly central line)
Left heart thrombus
Subacute bacterial endocarditis
Severe liver kidney disease
Diabetic retinal hemorrhage
Acute pancreatitis
Urgency

heparin is ARE not contraindication-often used to prevent propagation of clot including effort induced thrombosis

77
Q

Diagnosis with malignant epithelial cells from parotid mass with nerve symptoms

A

mucoid epidermoid carcinoma

most common MALIGNANT neoplasm of the parotid for both adults and children

78
Q

findings of multi-nodular goiter T3-T4 and ultrasound

A

elevated T3
Decrease T4

Ultrasound:
5 nodules greater than 1 cm
3 nodules less than 1 cm

79
Q

Treatment of of the nodular goiter

A

FNA

Iodine supplement over time - careful, can precipitate thyrotoxicosis

levothyroxin mainstay treatment 80% decrease goiter with this

Thyroidectomy if:
Increase nodule size
Nodules too numerous to perform FNA

NOT radio iodine ablation ( the treatment for Graves’ disease)

80
Q

What is iodine-131 methyliodobenzylguanidine (I-131 MIBIG) used to localize

A

adrenal pheochromocytoma

taken up and chromic and tissue

81
Q

test for Aldosteronoma

A

adrenal vein sampling

82
Q

test for insulinoma

A

endoscopic ultrasound

remember, octreotide not helpful

83
Q

localization study for gastrinoma

A

somatostatin (octreotide) scan/scintigraphy

84
Q

where due to renal arteries come off of the aorta compared other vessels

A

just below SMA

L2

85
Q

Relationship the right renal artery to IVC

A

under IVC on the way to kidney

86
Q

relationship of renal arteries to renal veins

A

renal vein anterior

87
Q

relationship or renal artery to ureters and renal pelvis

A

anterior to ureters plus pelvis

88
Q

initial treatment for ITP

A

steroids are only indicated if patient does symptomatically bleeding

or platelet count falls below 30,000

patient’s

89
Q

treatment of ITP patient with acute active bleed

A

IVIG

90
Q

3 indications for IVIG and ITP

A

acute active bleed

Preoperative

Before childbirth

91
Q

when his splenectomy indicated for ITP

A

failed medical management

Platelet count remains under 30,000 after 3 months of maximal treatment

92
Q

cervical intraepithelial neoplasia definition

A

CIN

PRE-malignant
identified on Pap smear

93
Q

cervical intraepithelial neoplasia treatment algorithm

A

mild dysplasia:
CIN-1
Often secondary to infection
Observe

Moderate-severe dysplasia
CIN-1-2
cryoablation or electrosurgical excision

QBANK MIX (28 decks)

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