MIX 7 QBANK Flashcards
treatment of bladder cancer transitional cell carcinoma
tumor confined to mucosal:
T1
Resection was intravesical BCG
Invades the muscle:
Radical cystectomy
Abdomen or neoadjuvant chemotherapy
brown common bile duct stones
associated with infection of biliary
black common bile duct stones
associated with hemolysis
Unconjugated bilirubin
Sickle cell
Hereditary spherocytosis
which usually presents first in MEN syndromes pheo or thyroid
thyroid
compared sporadic to hereditary pheochromocytomas
hereditary pheochromocytoma: Earlier age Multiple Bilateral Extruded renal RARELY malignant
best test for pheochromocytoma workup
PLASMA free metanephrine best test to exclude Pheochromocytoma (Cam- recent finding)
24-hour urine:
Catecholamines
Fractionated metanephrines
Vanillylmadelic acid
screening for hypercortisolism
low dose overnight dexamethasone suppression test 95% sensitive
24-hour urine free cortisol next at
if positive test for:
ACTH - tests for adrenal versus, pituitary, versus ectopic site
(Cam)
evening salivary cortisol maybe (Qbank)
survival of patient with mechanical valve versus bioprosthetic valve
equal
with bioprosthetic valve wears out faster
anticoagulation of mechanical valve versus bioprosthetic valve
mechanical-yes
Bioprosthetic-no
When should ventral hernia with mesh seroma be drained
persistent over 6-8 weeks
treatment of esophageal cancer perforation with contained leak versus free perforation
contained leak may consider antibiotics and observation
unusual causes of urgent esophagectomy
cancer
Achalasia
Severe peptic strictures
Caustic injury
Esophagectomy regardless of degree of inflammation or interval..
the the most common in a natural history of ASD
most are small and do not present symptoms until adulthood
Adult symptoms:
Dyspnea
Shortness of breath
Heart murmur
Cystic hygroma
benign fluid collection of lymph
Accumulated posterior neck most commonly
she seen on prenatal ultrasound
Treatment:
Observe
Surgery if -
Airway compromise
Infected
Hemorrhage
If risk to adjacent structures may consider injecting sclerosis
complication seen with nitroprusside
sign of toxicity
Pulmonary edema
Weakness confusion
Diagnosis: Thiocyanate level
Treatment:
Amyl nitrate
Sodium nitrite
Sodium thiosulfate
adverse effect of halothane
ventricular arrhythmia
Rarely hepatic necrosis
metabolism of sevoflurane
hepatic
advantages of isoflurane
vasodilator
Least myocardial depression ( but second-best when compared to nitrous oxide)
Enflurane vascular defects
also peripheral vasodilator
but more myocardia depression and isoflurane
effects of prostacyclin on platelet
inhibit platelet aggregation and is also a vasodilator
PGE1
prostaglandin analogs such as alprostadil or misoprostol (prostaglandin E1 analogs)
keeps PDA open
defined P. value when related to null hypophysis
probability of obtaining a result as extreme (or more extreme) than the one observed if the null hypothesis is true.
fluid status of SIADH patient
euvolemic
low urine sodium
fluid status cerebral salt wasting
hypovolemic
venous capacitance
somewhat analogous to vascular resistance but whereas vascular resistance relates to flow through a blood vessel, vascular capacitance relates to the volume contained in it.
The relationship between the volume of blood contained within a segment of vasculature and the pressure distending the vascular walls over a wide range of pressures and volumes. The veins of the body are not only conduits for the return of blood to the right heart, but they also determine most of the vascular capacitance and contain most of the blood volume. Changes in vascular capacitance provide a quick and effective mechanism for the filling of the right heart,
prognosticators for poor survival with extremity sarcoma
tumor size High grade Deep location subtype: 1.Leiomyosarcoma 2.malignant peripheral nerve tumor Symptoms recurrent disease positive margins
these are different from prognostic factors for local or distant recurrence
factors at increased local recurrence in extremities soft tissue sarcoma
age
Recurrent disease
Positive margins
subtype:
1. fibrosarcoma ( careful, this is not included having increasing for survival)
2. peripheral nerve tumor - this is shared with risk factors of survival
factor to increase distant recurrence and extremity soft tissue sarcoma
same as for prognosis but include:
non liposarcoma
tumor size High grade Deep location subtype: 1.Leiomyosarcoma 2.malignant peripheral nerve tumor Symptoms recurrent disease positive margins
these are different from prognostic factors for local or distant recurrence
what else is given other than dantrolene for malignant hyperthermia
insulin
Bicarbonate
physiologic effects of somatostatinoma
jaundice-inhibits pancreatic and biliary secretions
also present in proximal head of pancreas and ampulla
Gallstones
Diabetes-inhibition of insulin secretion
steatorrhea
diagnosis and treatment of somatostatinoma
somatostatin level greater than 10
attempt at complete excision as well as cholecystectomy
skin findings with what pancreatic tumor
glucagonoma
sticky itchy sugar skin
treat with amino acid
initial study of choice for suspected esophageal perforation with mediastinal findings on chest x-ray after Nissen
Gastrografin first in case there is a leak in the stomach as well
careful, barium is better for the chest
explaining why tamoxifen decreases estrogen breast and increase his risk of uterine cancer
Tamoxifen, a selective estrogen receptor modifier (SERM) although labeled as an antiestrogen, acts as a weak estrogen in some tissues. It is inhibitory in breast tissue, yet stimulatory in the endometrium
ABCD rule skin cancer
higher cancer risk.
A – Asymmetry,
B – irregular Border,
C – nonuniform Color,
D – Diameter > 6 mm.
management of squamous cell carcinoma the neck unknown primary
radiation of oropharynx and bilateral neck
Most common site of origin of squamous cell carcinoma the neck with unknown primary
80% from oropharynx
Most common tonsil involved is ipsilateral
However, its base of tongue need bilateral node radiation
diagnostic tests can be used to differentiate between a pituitary secreting adenoma and ectopic ACTH production
high dose dexamethasone suppression test
workup for Cushing’s
24-hour he urine free cortisol
Elevated: Probable Cushing’s syndrome
ACTH:
Present
pituitary MRI and high dose dexamethasone suppression:
mass-transsphenoidal pituitary microsurgery
no mass:
Bilateral inferior petrosal sinus sample-
gradient found:
Transsphenoidal pituitary microsurgery
no gradient found:
Chest abdominal CT
Somatostatin receptor scintigraphy
ACTH not present:
CT of the adrenals
24-hour urine frequent result negative (x2):
late evening salivary cortisol x2
if positive: ACTH operative
if negative: Cushing’s unlikely
does ACTH with pituitary source of Cushing’s suppressed with high dose dexamethasone
YES
ectopic does not suppress
NASCET trial
symptomatic
Greater than 70% stenosis
at 2 years:
Surgery group 9% stroke
Medical group 26% stroke
ACAS Trial
asymptomatic
greater than 60% stenosis
at 5 years:
Surgery group 5% stroke
Medical group 11% stroke
because of urinary retention after hemorrhage surgery
muscle spasm pelvic floor
NOT lidocaine
paraneoplastic syndrome associated with small cell lung cancer
ACTH
SIADH
The a’s are the smallest letter of the alphabet
ACTH
ADH
or perineoplastic syndrome was associated with a squamous cell of the lung
parathyroid hormone related peptide
medication use for pulmonary hypertension
milrinone
Viagra
pressor used to maintain brain heart and kidney perfusion
dopamine
inotropic support in order to maintain brain, heart, and kidney perfusion.
increased heart rate, increased contractility, and peripheral vasoconstriction
effects of high dose dopamine
off adrenergic
Can cause significant coronary vasoconstriction-angina increased pulmonary hypertension
vessel effects with nitroglycerin
artery and venous smooth muscle dilator
primarily increased venous capacitance
higher doses relaxed arterial tone
vessel effects with hydralazine
arterial vasodilation - peripheral
nerves at risk and distal to external iliac artery laparoscopic hernia repair
Gen. femoral
lateral femoral cutaneous
multiple to initiate extravasation of leukocytes from blood vessel causing them to roll on endothelium
E-selectin
ICAM-1 is a second stab
TNFa also involved
neural control of the external anal sphincter
voluntary
Branches of the internal pudendal
AND
S4
to management of duodenal obstruction first portion of the duodenum with Crohn’s
Gastro-J. bypass
stricturoplasty does not work well in here
would have and the venous capacitance and septic shock
increases
movement is a diaphragmatic injury repaired abdominally versus thoracic
abdominally within first week
Thoracic and chronic
Best outcome for peripheral angioplasty patency
iliac
worsens distally
incision for proximal control of the innominate artery
MEDIAN sternotomy
structures accessible from median sternotomy
descending aorta Aortic arch Innominate Right subclavian LEFT common carotid
structures accessible from supraclavicular or infraclavicular incision
axillary artery
Subclavian artery
Does not allow for control of innominate coming off the aorta
incision exposure for left subclavian proximal control
third interspace anterior thoracotomy
Milan Criteria
appropriate candidate for transplant with hepatocellular carcinoma
Single lesion less than 5 cm
2-3 lesions each less than 3 cm
no major vessel involvement
no extrahepatic metastases
blood to the esophagus
cervical-subclavian, thyrocervical trunk, inferior thyroid
Thoracic- aorta branches
abdominal- LEFT GASTRIC artery
symptoms of mitral valve stenosis - with what workup findings in what presentation
normal bile 4-6 cm
severe stenosis :
less than 1 cm
gradient greater than 10
increased left atrial pressure 25 Pulmonary hypertension pulmonary edema secondary right heart failure JVD
NOT synchope seen with aortic stenosis
position of anterior hip dislocation and complication
ABducted
EXTERNALLY rotated
Femoral head overlying obturator foramen
avascular necrosis
most common cause of postcholecystectomy bile leak
loss clip from the cystic duct after inflammation
qbank did not consider this technical
management of duct of Luscha bile leak after cholecystectomy
ALSO with stent
vitamin C pathway of collagen synth and what other constituents are required
hydroxylation of lysine and Prolene
as well as cross-link
iron
alpha ketoglutarate
4 leg compartments
anterior - greatest risk of compartment syndrome
Lateral
Superficial posterior
The posterior
border of return of function of GI system Post operation
small bowel hours
Stomach 24-48 hours
Colon 48-72 hours
diagnosis with corkscrew esophagus
diffuse esophageal spasm
management of diffuse esophageal spasm
medical
Endoscopic bougie dilatation - 70-80% success
long esophageal myotomy for refractory entire length of esophagus when abnormal manometry is confirmed
antibiotic for fight bite including alternatives and penicillin allergy
amoxicillin clavulanic acid
other choices:
pipercillin tazobactam
cefotetan
cefoxitin
penicillin allergy:
Doxycycline
Most common bacteria human bite
Bacteroides
produce beta-lactamase
E. Corrodens
Corynebacterium - common in human bite-gram-positive rod
flow velocities by stenosis: 50%, 50-69%, greater than 70%
less than 50%-125 cm/s
50-69%-100-230 cm/s
greater than 70%-greater than 230 cm/s
significant calcifications and pulmonary nodule
BENIGN
Careful, thyroid and breast calcifications concerning for cancer
pulmonary lesion doubling time associated with cancer
one month one year
over one year more likely benign
criteria to follow only with plain film chest x-ray no CT scan for pulmonary nodule
less than 5 mm and:
Smooth borders
risk of lung cancer with nodule over 50-year-old
50%!
Associated with some malignancy
standard of care for a patient with metastatic renal cell carcinoma
neoadjuvant nephrectomy
Interleukin-2 and interferon
contraindications to use ketamine
elevated intracranial pressure-increases cerebral blood flow
Open eye injuries and eye disorders increase his intraocular pressure
Ischemic heart disease-increases rate and blood pressure-increased myocardial oxygen consumption
toxic administered in epidural
characteristics of malignant pheochromocytoma
neuroectodermal tissue found and locations bed does not demonstrate this tissue normally
axial skeleton Nodes Liver Lungs Kidneys
muscle resection that improves exposure common carotid artery
omohyoid
muscle resection improved exposure of the internal carotid artery
the digastric
most important prognosticator of soft tissue sarcoma of the extremity
mycotic index-histology - amount of necrosis
when his chemotherapy helpful and soft tissue sarcoma
possibly Ewing sarcoma
other soft tissue sarcomas of the extremities treated with radiation as first choice for adjuvant
most common genetic defect and colon cancer
APC gene
Careful, this is also seen in FAP
most common organism to cause overwhelming postsplenectomy infection
Streptococcus pneumoniae-90% cases overall
treatment if pituitary surgery has failed and continued Cushing’s
second attempt resection
or
postoperative radiation may improve remission rates if surgery failed
bilateral adrenalectomy - last resort
success of curing Cushing’s syndrome with adrenalectomy
90%!
Excessive tearing Cushing’s disease with pituitary adenoma microsurgery
75%
GCS
none
stim
Voice
Spontaneous
None Incomprehensible inappropriate Confused Oriented
none Decerebrate Decorticate Withdrawal Localize Comand
treatment of threatened extremity from embolus with a recent MI
thrombolytic
Gen. anesthesia relative contraindication to embolectomy
amount of fluid that can be seen on chest x-ray
300 mL
whereas most of the pulmonary fluid resorbed
PARIETAL pleura has most the lymphatics
pleural serum ratio of protein consistent with transudate
no
less than 0.5?
Concomitant cholecystectomy with AAA repair if gallstones found?
No
weight of opinion has shifted away from synchronous cholecystectomy.
concomitant resection of Solid tumors of the spleen, liver, and adrenal gland the time of AAA repair
appears reasonable
as long as patient can tolerate
Giventhe typically sterile nature of these organs,
Current data support open aneurysm repair at a threshold size of
5.5 cm in men and 5.0 cm in women.
recent travel, abdominal pain, fever, vomiting heterogenous cyst right lobe calcified - diagnosis and treatment
HYDATID cyst
echinococcosis
albendazole or mebendazole - preop is reasonable but his therapy alone 50% disappearance
select groups of patients who cannot tolerate a major procedure or the cyst appears small and heavily calcified. Percutaneous aspiration is not recommended due to the risk of anaphylaxis.
Lachman test
The knee is flexed at 30 degrees
Examiner pulls on the tibia to assess the amount of anterior motion of the tibia in comparison to the femur
where the majority of protein digestion and absorption occur
jejunum 80-90%
what tissue layer is chronic body tumor found in
posterior medial adventitia
nerve crest-ectodermal
paraganglia extra-adrenal
most common presentation of carotid body tumor
typically are asymptomatic
can present with neck pain, dysphonia, hoarseness, stridor, dysphagia, or sore throat. In rare occasions these tumors can present with extraadrenal like symptoms such as palpitations, tachycardia, and hypertension.
tumor associated with Pancoast tumor, symptoms and treatment
SQUAMOUS cell lung cancer
neural INVASION
ulnar nerve distribution, infected
sympathetic chain-Horner syndrome
first line treatment:
radiation
RARE tumor is amenable to surgery require en bloc rib resections
most common cause of pyogenic liver abscess
biliary obstruction:
Strong, stricture
Iatrogenic, stent
was common site of pyogenic liver abscess
RIGHT - preferential blood flow to right side
was common pathogens of pyogenic liver abscess
Escherichia coli
Klebsiella
LFTs and pyogenic versus amoebic abscess of the liver
pyogenic LFTs elevated more commonly
Hunter’s canal structures in the canal and boundaries
also called adductor canal
superficial femoral artery and vein
saphenous nerve
Vastus medialis
Careful, this is the anterior and lateral border
Abductor magnus and longus-posterior border
Sartorius-roof and medial border
which is more important prognosticator for malignant melanoma thickness or nodes
nodes
other prognosticators: Thickness Mitotic rate Ulceration LDH
factor associated with platelet aggregation and vasoconstriction in wound healing
Thromboxane A2
most common type non-small cell lung cancer
squamous cell
Large cell
Adenocarcinoma
stage of lung cancer positive ipsilateral mediastinal node
into
Stage IIIa
stage of lung cancer T4 lesion
stage III regardless of nodal status
with the exception to metastatic guideline for lung cancer with resection surgery as treatment
Rarely, isolated metastases can be resected from the:
Brain!
Adrenal gland!
anterior cord syndrome
loss of
motor
pain and temperature
maintained
proprioception
find touch
Brown-Séquard syndrome
Hemisection injury to cord
ipsilateral motor and proprioception
contralateral pain and temperature
central cord syndrome
usually cervical
Upper extremity motor loss
Lower extremity with some preservation
Sacral sensory spared
cauda equina syndrome
lumbosacral nerve roots
The reflected bowel or bladder
Variable motor and sensory loss to the lower limbs
posterior cord syndrome
loss of proprioception vibration only
Collateral and branch contributions to the anterior spinal cord perfusion
Adamkiewicz
anterior spinal, intercostal, and lumbar arteries
