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QBANK MIX > MIX 7 QBANK > Flashcards

MIX 7 QBANK Flashcards

1
Q

treatment of bladder cancer transitional cell carcinoma

A

tumor confined to mucosal:
T1
Resection was intravesical BCG

Invades the muscle:
Radical cystectomy
Abdomen or neoadjuvant chemotherapy

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2
Q

brown common bile duct stones

A

associated with infection of biliary

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3
Q

black common bile duct stones

A

associated with hemolysis

Unconjugated bilirubin

Sickle cell

Hereditary spherocytosis

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4
Q

which usually presents first in MEN syndromes pheo or thyroid

A

thyroid

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5
Q

compared sporadic to hereditary pheochromocytomas

A 
hereditary pheochromocytoma:
Earlier age
Multiple
Bilateral
Extruded renal
RARELY malignant
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6
Q

best test for pheochromocytoma workup

A

PLASMA free metanephrine best test to exclude Pheochromocytoma (Cam- recent finding)

24-hour urine:
Catecholamines
Fractionated metanephrines
Vanillylmadelic acid

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7
Q

screening for hypercortisolism

A

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)

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8
Q

survival of patient with mechanical valve versus bioprosthetic valve

A

equal

with bioprosthetic valve wears out faster

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9
Q

anticoagulation of mechanical valve versus bioprosthetic valve

A

mechanical-yes

Bioprosthetic-no

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10
Q

When should ventral hernia with mesh seroma be drained

A

persistent over 6-8 weeks

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11
Q

treatment of esophageal cancer perforation with contained leak versus free perforation

A

contained leak may consider antibiotics and observation

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12
Q

unusual causes of urgent esophagectomy

A

cancer
Achalasia
Severe peptic strictures
Caustic injury

Esophagectomy regardless of degree of inflammation or interval..

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13
Q

the the most common in a natural history of ASD

A

most are small and do not present symptoms until adulthood

Adult symptoms:
Dyspnea
Shortness of breath
Heart murmur

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14
Q

Cystic hygroma

A

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

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15
Q

complication seen with nitroprusside

A

sign of toxicity

Pulmonary edema
Weakness confusion

Diagnosis: Thiocyanate level

Treatment:
Amyl nitrate
Sodium nitrite
Sodium thiosulfate

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16
Q

adverse effect of halothane

A

ventricular arrhythmia

Rarely hepatic necrosis

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17
Q

metabolism of sevoflurane

A

hepatic

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18
Q

advantages of isoflurane

A

vasodilator

Least myocardial depression ( but second-best when compared to nitrous oxide)

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19
Q

Enflurane vascular defects

A

also peripheral vasodilator

but more myocardia depression and isoflurane

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20
Q

effects of prostacyclin on platelet

A

inhibit platelet aggregation and is also a vasodilator

PGE1
prostaglandin analogs such as alprostadil or misoprostol (prostaglandin E1 analogs)
keeps PDA open

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21
Q

defined P. value when related to null hypophysis

A

probability of obtaining a result as extreme (or more extreme) than the one observed if the null hypothesis is true.

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22
Q

fluid status of SIADH patient

A

euvolemic

low urine sodium

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23
Q

fluid status cerebral salt wasting

A

hypovolemic

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24
Q

venous capacitance

A

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,

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25
Q

prognosticators for poor survival with extremity sarcoma

A 
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

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26
Q

factors at increased local recurrence in extremities soft tissue sarcoma

A

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

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27
Q

factor to increase distant recurrence and extremity soft tissue sarcoma

A

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

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28
Q

what else is given other than dantrolene for malignant hyperthermia

A

insulin

Bicarbonate

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29
Q

physiologic effects of somatostatinoma

A

jaundice-inhibits pancreatic and biliary secretions
also present in proximal head of pancreas and ampulla
Gallstones
Diabetes-inhibition of insulin secretion
steatorrhea

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30
Q

diagnosis and treatment of somatostatinoma

A

somatostatin level greater than 10

attempt at complete excision as well as cholecystectomy

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31
Q

skin findings with what pancreatic tumor

A

glucagonoma

sticky itchy sugar skin

treat with amino acid

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32
Q

initial study of choice for suspected esophageal perforation with mediastinal findings on chest x-ray after Nissen

A

Gastrografin first in case there is a leak in the stomach as well

careful, barium is better for the chest

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33
Q

explaining why tamoxifen decreases estrogen breast and increase his risk of uterine cancer

A

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

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34
Q

ABCD rule skin cancer

A

higher cancer risk.

A – Asymmetry,
B – irregular Border,
C – nonuniform Color,
D – Diameter > 6 mm.

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35
Q

management of squamous cell carcinoma the neck unknown primary

A

radiation of oropharynx and bilateral neck

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36
Q

Most common site of origin of squamous cell carcinoma the neck with unknown primary

A

80% from oropharynx

Most common tonsil involved is ipsilateral

However, its base of tongue need bilateral node radiation

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37
Q

diagnostic tests can be used to differentiate between a pituitary secreting adenoma and ectopic ACTH production

A

high dose dexamethasone suppression test

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38
Q

workup for Cushing’s

A

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

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39
Q

does ACTH with pituitary source of Cushing’s suppressed with high dose dexamethasone

A

YES

ectopic does not suppress

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40
Q

NASCET trial

A

symptomatic

Greater than 70% stenosis

at 2 years:
Surgery group 9% stroke
Medical group 26% stroke

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41
Q

ACAS Trial

A

asymptomatic

greater than 60% stenosis

at 5 years:
Surgery group 5% stroke
Medical group 11% stroke

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42
Q

because of urinary retention after hemorrhage surgery

A

muscle spasm pelvic floor

NOT lidocaine

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43
Q

paraneoplastic syndrome associated with small cell lung cancer

A

ACTH
SIADH

The a’s are the smallest letter of the alphabet
ACTH
ADH

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44
Q

or perineoplastic syndrome was associated with a squamous cell of the lung

A

parathyroid hormone related peptide

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45
Q

medication use for pulmonary hypertension

A

milrinone

Viagra

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46
Q

pressor used to maintain brain heart and kidney perfusion

A

dopamine

inotropic support in order to maintain brain, heart, and kidney perfusion.

increased heart rate, increased contractility, and peripheral vasoconstriction

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47
Q

effects of high dose dopamine

A

off adrenergic

Can cause significant coronary vasoconstriction-angina increased pulmonary hypertension

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48
Q

vessel effects with nitroglycerin

A

artery and venous smooth muscle dilator

primarily increased venous capacitance

higher doses relaxed arterial tone

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49
Q

vessel effects with hydralazine

A

arterial vasodilation - peripheral

50
Q

nerves at risk and distal to external iliac artery laparoscopic hernia repair

A

Gen. femoral

lateral femoral cutaneous

51
Q

multiple to initiate extravasation of leukocytes from blood vessel causing them to roll on endothelium

A

E-selectin

ICAM-1 is a second stab

TNFa also involved

52
Q

neural control of the external anal sphincter

A

voluntary

Branches of the internal pudendal
AND
S4

53
Q

to management of duodenal obstruction first portion of the duodenum with Crohn’s

A

Gastro-J. bypass

stricturoplasty does not work well in here

54
Q

would have and the venous capacitance and septic shock

A

increases

55
Q

movement is a diaphragmatic injury repaired abdominally versus thoracic

A

abdominally within first week

Thoracic and chronic

56
Q

Best outcome for peripheral angioplasty patency

A

iliac

worsens distally

57
Q

incision for proximal control of the innominate artery

A

MEDIAN sternotomy

58
Q

structures accessible from median sternotomy

A 
descending aorta
Aortic arch
Innominate
Right subclavian
LEFT common carotid
59
Q

structures accessible from supraclavicular or infraclavicular incision

A

axillary artery
Subclavian artery

Does not allow for control of innominate coming off the aorta

60
Q

incision exposure for left subclavian proximal control

A

third interspace anterior thoracotomy

61
Q

Milan Criteria

A

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

62
Q

blood to the esophagus

A

cervical-subclavian, thyrocervical trunk, inferior thyroid

Thoracic- aorta branches

abdominal- LEFT GASTRIC artery

63
Q

symptoms of mitral valve stenosis - with what workup findings in what presentation

A

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

64
Q

position of anterior hip dislocation and complication

A

ABducted
EXTERNALLY rotated
Femoral head overlying obturator foramen

avascular necrosis

65
Q

most common cause of postcholecystectomy bile leak

A

loss clip from the cystic duct after inflammation

qbank did not consider this technical

66
Q

management of duct of Luscha bile leak after cholecystectomy

A

ALSO with stent

67
Q

vitamin C pathway of collagen synth and what other constituents are required

A

hydroxylation of lysine and Prolene

as well as cross-link

iron
alpha ketoglutarate

68
Q

4 leg compartments

A

anterior - greatest risk of compartment syndrome
Lateral
Superficial posterior
The posterior

69
Q

border of return of function of GI system Post operation

A

small bowel hours
Stomach 24-48 hours
Colon 48-72 hours

70
Q

diagnosis with corkscrew esophagus

A

diffuse esophageal spasm

71
Q

management of diffuse esophageal spasm

A

medical
Endoscopic bougie dilatation - 70-80% success

long esophageal myotomy for refractory entire length of esophagus when abnormal manometry is confirmed

72
Q

antibiotic for fight bite including alternatives and penicillin allergy

A

amoxicillin clavulanic acid

other choices:

pipercillin tazobactam
cefotetan
cefoxitin

penicillin allergy:
Doxycycline

73
Q

Most common bacteria human bite

A

Bacteroides
produce beta-lactamase

E. Corrodens
Corynebacterium - common in human bite-gram-positive rod

74
Q

flow velocities by stenosis: 50%, 50-69%, greater than 70%

A

less than 50%-125 cm/s
50-69%-100-230 cm/s
greater than 70%-greater than 230 cm/s

75
Q

significant calcifications and pulmonary nodule

A

BENIGN

Careful, thyroid and breast calcifications concerning for cancer

76
Q

pulmonary lesion doubling time associated with cancer

A

one month one year

over one year more likely benign

77
Q

criteria to follow only with plain film chest x-ray no CT scan for pulmonary nodule

A

less than 5 mm and:

Smooth borders

78
Q

risk of lung cancer with nodule over 50-year-old

A

50%!

Associated with some malignancy

79
Q

standard of care for a patient with metastatic renal cell carcinoma

A

neoadjuvant nephrectomy

Interleukin-2 and interferon

80
Q

contraindications to use ketamine

A

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

81
Q

characteristics of malignant pheochromocytoma

A

neuroectodermal tissue found and locations bed does not demonstrate this tissue normally

 axial skeleton
Nodes
Liver
Lungs
Kidneys
82
Q

muscle resection that improves exposure common carotid artery

A

omohyoid

83
Q

muscle resection improved exposure of the internal carotid artery

A

the digastric

84
Q

most important prognosticator of soft tissue sarcoma of the extremity

A

mycotic index-histology - amount of necrosis

85
Q

when his chemotherapy helpful and soft tissue sarcoma

A

possibly Ewing sarcoma

other soft tissue sarcomas of the extremities treated with radiation as first choice for adjuvant

86
Q

most common genetic defect and colon cancer

A

APC gene

Careful, this is also seen in FAP

87
Q

most common organism to cause overwhelming postsplenectomy infection

A

Streptococcus pneumoniae-90% cases overall

88
Q

treatment if pituitary surgery has failed and continued Cushing’s

A

second attempt resection

or

postoperative radiation may improve remission rates if surgery failed

bilateral adrenalectomy - last resort

89
Q

success of curing Cushing’s syndrome with adrenalectomy

A

90%!

90
Q

Excessive tearing Cushing’s disease with pituitary adenoma microsurgery

A

75%

91
Q

GCS

A

none
stim
Voice
Spontaneous

None
Incomprehensible
inappropriate
Confused
Oriented
 none
Decerebrate
Decorticate
Withdrawal
Localize
Comand
92
Q

treatment of threatened extremity from embolus with a recent MI

A

thrombolytic

Gen. anesthesia relative contraindication to embolectomy

93
Q

amount of fluid that can be seen on chest x-ray

A

300 mL

94
Q

whereas most of the pulmonary fluid resorbed

A

PARIETAL pleura has most the lymphatics

95
Q

pleural serum ratio of protein consistent with transudate

A

no

less than 0.5?

96
Q

Concomitant cholecystectomy with AAA repair if gallstones found?

A

No

weight of opinion has shifted away from synchronous cholecystectomy.

97
Q

concomitant resection of Solid tumors of the spleen, liver, and adrenal gland the time of AAA repair

A

appears reasonable
as long as patient can tolerate

Giventhe typically sterile nature of these organs,

98
Q

Current data support open aneurysm repair at a threshold size of

A

5.5 cm in men and 5.0 cm in women.

99
Q

recent travel, abdominal pain, fever, vomiting heterogenous cyst right lobe calcified - diagnosis and treatment

A

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.

100
Q

Lachman test

A

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

101
Q

where the majority of protein digestion and absorption occur

A

jejunum 80-90%

102
Q

what tissue layer is chronic body tumor found in

A

posterior medial adventitia

nerve crest-ectodermal

paraganglia extra-adrenal

103
Q

most common presentation of carotid body tumor

A

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.

104
Q

tumor associated with Pancoast tumor, symptoms and treatment

A

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

105
Q

most common cause of pyogenic liver abscess

A

biliary obstruction:
Strong, stricture
Iatrogenic, stent

106
Q

was common site of pyogenic liver abscess

A

RIGHT - preferential blood flow to right side

107
Q

was common pathogens of pyogenic liver abscess

A

Escherichia coli

Klebsiella

108
Q

LFTs and pyogenic versus amoebic abscess of the liver

A

pyogenic LFTs elevated more commonly

109
Q

Hunter’s canal structures in the canal and boundaries

A

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

110
Q

which is more important prognosticator for malignant melanoma thickness or nodes

A

nodes

 other prognosticators:
Thickness
Mitotic rate
Ulceration
LDH
111
Q

factor associated with platelet aggregation and vasoconstriction in wound healing

A

Thromboxane A2

112
Q

most common type non-small cell lung cancer

A

squamous cell
Large cell
Adenocarcinoma

113
Q

stage of lung cancer positive ipsilateral mediastinal node

A

into

Stage IIIa

114
Q

stage of lung cancer T4 lesion

A

stage III regardless of nodal status

115
Q

with the exception to metastatic guideline for lung cancer with resection surgery as treatment

A

Rarely, isolated metastases can be resected from the:
Brain!
Adrenal gland!

116
Q

anterior cord syndrome

A

loss of
motor
pain and temperature

maintained
proprioception
find touch

117
Q

Brown-Séquard syndrome

A

Hemisection injury to cord

ipsilateral motor and proprioception

contralateral pain and temperature

118
Q

central cord syndrome

A

usually cervical

Upper extremity motor loss

Lower extremity with some preservation

Sacral sensory spared

119
Q

cauda equina syndrome

A

lumbosacral nerve roots

The reflected bowel or bladder

Variable motor and sensory loss to the lower limbs

120
Q

posterior cord syndrome

A

loss of proprioception vibration only

121
Q

Collateral and branch contributions to the anterior spinal cord perfusion

A

Adamkiewicz

anterior spinal, intercostal, and lumbar arteries

QBANK MIX (28 decks)

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