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