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QBANK MIX > MIX 8 QBANK > Flashcards

MIX 8 QBANK Flashcards

1
Q

GB adverse effect of ceftriaxone

A

can cause GB SLUDGE

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2
Q

course of cystic artery compared to common hepatic duct

A

POSTERIOR

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3
Q

cystic artery variations

A

GDA
SMA
COMMON hepatic artery

Usually comes off RIGHT hepatic

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4
Q

primary source of bilirubin in the body

A

Senescent red blood cells

Whether due to aged cells or active hemolysis, hemoglobin is broken down into bilirubin and ultimately secreted into bile.

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5
Q

incidence of TIPS shunt stenosis

A

(up to 50%)

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6
Q

TIPS is what kind of shunt

A

side-to-side portosystemic shunt

nonselective shunt and completely diverts portal flow

TIPS is also effective in the treatment of medically intractable ascites

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7
Q

major cause of TIPS Shunt stenosis

A

neointimal hyperplasia

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8
Q

treatment of TIPS Shunt stenosis

A

often be resolved by balloon dilation

in some cases, by placement of a second shunt.

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9
Q

frequency of post-TIPS encephalopathy

A

(∼30%)

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10
Q

effectiveness of TIPS compared to endscopic tx of bleeding

A

TIPS more effective

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11
Q

effect of TIPS on pts requireing liver transplant

A

HELP temporize them!

does not mess with vasculature

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12
Q

risk factors associated with melanoma

A 
UVA and UVB radiation
congenital nevi, 
dysplastic nevi, 
xeroderma pigmentosa,
family history

NOT actinic keratoses
(careful, actinic keratoses IS risk for squamous)

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13
Q

tx of Immediate sensory and motor deficits after creation of an arteriovenous fistula

A

requires immediate ligation

NOT DRIL

The DRIL (distal revascularization - interval ligation) procedure is used in patients that do not have dramatic symptoms in the immediate postoperative period

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14
Q

treatment of symptomatic Meckel’s diverticulum

A

Uncomplicated:
Diverticulectomy only

complicated:
Diverticulitis, GI bleeding, wide-based-
segmental resection

wait for obstructive symptoms to resolve?

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15
Q

Diagnosis of Zenker’s diverticulum

A

barium swallow

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16
Q

incision for opened Zenker’s diverticulum

A

left neck

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17
Q

when is a myotomy alone sufficient for Zenker’s

A

diverticulum less than 2 cm

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18
Q

when is diverticulo pexy performed for Zenker’s

A

elderly patients

LARGE diverticula to avoid complications of resection

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19
Q

prophylactic pre-incision antibiotics for colon surgery

A

second generation cephalosporin
cefoxitin
Cefotetan

or

Cefazolin and Flagyl

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20
Q

winded a therapeutic course of antibiotics recommended instead of just prophylactic pre-incision antibiotics for trauma

A

greater than 6 hours and time of injury

Signs of infection intraoperatively

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21
Q

symptoms of hypoglossal nerve injury

A

IPSILATERAL (towards the site of injury)

Tongue deviation

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22
Q

marginal mandibular nerve

A

branch of the facial nerve
“motor car”
Retraction and angle of mandible
Drooping of ipsilateral lip

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23
Q

site of injury from deceleration trauma of aorta

A

ligamentum arteriosum

just distal to subclavian

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24
Q

A 26-year-old female with a 3 cm heterogeneously enhancing hepatic lesion

A

adenoma

less than 4 cm and is asymptomatic, it does not need to be resected. If the patient is taking oral contraceptive pills (OCP), she should be advised to discontinue them.

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25
Q

margin for hepatic colorectal cancer metastasis

A

1 cm

Surgery give the best chance for cure

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26
Q

5 cm peripheral and centripetal enhancing hepatic lesion on CT

A

Cavernous hemangioma

does not need resection unless symptomatic

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27
Q

A 36-year-old female with a left hepatic liver lesion that has a central stellate scar

A

focal nodular hyperplasia

No malignant potential

Does not need resection unless symptomatic or cannot be definitively differentiated from cancer

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28
Q

Treatment of hepatocellular carcinoma with involvement of the portal vein

A

no surgery

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29
Q

proper location to administer an ilioinguinal nerve block?

A

1 cm medial and 1 cm inferior to the anterior superior iliac spine

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30
Q

when does carcinoid syndrome develop

A

small bowel ( ileum) - large portion of the liver must be replaced with carcinoid tumor for symptoms

careful, not with rectal

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31
Q

what our exceptions or carcinoid tumors develop more commonly with rare primary locations

A

organs the bypass hepatic circulation:
Ovary
Testes
Lung

these produce carcinoid syndrome without hepatic metastases

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32
Q

signs of air embolus

A

cardiovascular collapse,
dysrrhythmias,
characteristic “Mill wheel” murmur.

pulmonary artery hypertension,
elevated central venous pressure,
jugular venous distension.

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33
Q

most common cause of dialysis unit is now having difficulty using the fistula long term

A

outflow stenosis - typically intimal hyperplasia

occurs anywhere in the vein of an AV fistula
or
at the anastomosis of an AV graft

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34
Q

most common type of melanoma

A

superficial spreading
initial growth a radial-been potential for vertical

Careful, the prognosis is lentigo melanoma

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35
Q

most common melanoma an elderly

A

lentigo melanoma

best prognosis

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36
Q

type of melanoma with worse overall prognosis

A

nodular–vertical growth phase

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37
Q

when do type II pneumothorax began to develop

A

24 weeks
Careful, there is not adequate surfactant until 35 weeks

Continue develop after birth

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38
Q

which is more common type I or type II pneumocytes sites

A

type II

careful, lower surface area and a type II than type I
however, type I cover 95% of alveolar surface

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39
Q

enzyme that activate trypsinogen and where it is found

A

enterococci

Duodenum

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40
Q

enzymes that are secreted from the pancreas in active form

A

lipase
Amylase
ribonuclease

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41
Q

mechanism of trypsin and chemotrypsin

A

protein breakdown

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42
Q

extracolonic manifestations that will improve after colectomy for ulcerative colitis

A

erythema nodosum
Arthritis
Ankylosing spondylitis
Pyoderma gangrenosum

NOT PSC

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43
Q

treatment for primary sclerosing cholangitis

A

liver transplant

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44
Q

percentage of splenic artery aneurysms that present with year-old bleed; and percent mortality with rupture

A

20-30% present with abdominal pain and contained rupture and lesser sac - free rupture within 48 hours

( 20-50% rupture risk)

25% mortality with rupture

80-90% maternal and fetal mortality with rupture

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45
Q

treatment of splenic artery aneurysm

A

ligation or embolization of both the proximal and distal aspects of the aneurysm

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46
Q

most common side effects with pancuronium

A

tachycardia

coronary artery disease relative contraindication

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47
Q

side effects of succinylcholine

A 
hyperkalemia with:
Spinal cord injury
Burn
Rhabdo -  including prolonged immobilization
 renal disease
Others:
Malignant hyperthermia
Rhabdomyolysis
Ocular hypertension
Muscle pain

used for rapid sequence intubation

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48
Q

clearance of vecuronium

A

BOTH liver and kidney

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49
Q

with organ dysfunction is Atracurium good for and what is a side effect

A

minimal cardiac fracture

histamine release - vasodilated

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50
Q

pathophysiology of developing ascites from cirrhosis

A

fibrotic and parasites lead to portal hypertension

Lymphatic bed of liver and splenic neck lymph nodes began to leak into the peritoneum

This includes protein losses-hence the reason for albumin administration

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51
Q

mechanism of elimination of succinylcholine

A

pseudocholinesterase

only depolarizing agent

rapid onset and short half-life

Patient’s may be deficient in pseudocholinesterase - prolonged half-life

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52
Q

best prophylaxis for contrast-induced nephropathy

A

fluid hydration

no significant benefits of:
Mucomyst
Bicarbonate
Dopamine

With hold:
Loop diuretic
ACE inhibitor
Angiotensin II antagonists

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53
Q

Risk factors for contrast-induced nephropathy

A 
multiple myeloma
Proteinuria
Diabetes mellitus
Dehydration
concomitant other nephrotoxic drugs
Renal failure
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54
Q

what part of the kidney does contrast injure

A

renal tubule

Transient regional ischemia

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55
Q

acute cholangitis bacteria

A

Escherichia coli
Klebsiella

Others:
Bacteroides stridulous
Streptococcus faecalis

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56
Q

the tissue named vessels branches of the external iliac artery

A

deep circumflex iliac:
collateralizes with lateral femoral circumflex artery to the superior iliac spine also supplies collaterals to lower leg

Inferior epigastric (careful, pelvis and abdomen origin) - this vessel anastomosis with superior epigastric artery which is a branch of the internal thoracic

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57
Q

management of splenic abscess

A

IV antibiotics splenectomy-particularly of multiloculated and complex

possible IV antibiotics and CT-guided drainage-however, risky for bleeding only considered with unilocular simple abscess

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58
Q

time frame of intimal hyperplasia seen for graft stenosis

A

within 2 years of surgery

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59
Q

Cells involved with intimal hyperplasia

A

Spindle cells

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60
Q

Treatment of intimal hyperplasia and graft

A

Most effective after 6 months
balloon angioplasty using cutting balloon

early within 3 months:
Patch angioplasty
or
vein graft

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61
Q

what timeframe does atherosclerosis of graft usually occur

A

after 2 years

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62
Q

most common location of indirect inguinal hernia sac compared to cord structures and cremasteric muscle

A

deep to cremaster

Anterior and superior to spermatic cord -
hernia sac is carefully Divided off of cord structures

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63
Q

when can sigmoid ischemia be watched after triple-A repair regarding endoscopic findings

A

ischemia limited to the mucosa
Adequate perfusion
Antibiotics and bowel rest

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64
Q

physical symptoms of myasthenia gravis

A

ptosis
Diplopia
Weakness with repetitive movements
Fatigue

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65
Q

Percentage of myasthenia gravis patient who will have associated thymoma

A

only 10%!

thymectomy anyway

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66
Q

Percentage of patients with thymoma who will have myasthenia gravis

A

50%

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67
Q

percentage of improvement and myasthenia gravis after thymectomy

A

80%?

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68
Q

Pathway of conversion synthesis of catecholamine and adrenal medulla

A 
Tyrosine - all starts with going in the ring
L. dopamine - the dop
Dopamine - gets dop
Norepinephrine -  starts getting adrenl
Epinephrine - gets adren
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69
Q

only site of epinephrine production

A

adrenal medulla

converting norepinephrine to epinephrine

enzyme:
PNMT - final step path

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70
Q

steps and reducing the phimosis and possible complication

A

dilated with surgical clamp
Dorsal slit circumcision by urologist to temporize

paraphimosis - prepuce is trapped behind the glans-this is a urologic emergency - arterial flow continues without any risk or lymphatic congestion

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71
Q

treatment of paraphimosis

A

neurologic emergency

Emergent reduction required of pharphimosis in all circumstances

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72
Q

algorithm for hematochezia

A

NG lavage rule out upper GI

NG lavage negative colon
Bleeding intermittent and stable-colonoscopy

Brisk bleeding:
Colonoscopy not helpful can’t see anything

Localization study:
Angiography-diagnostic and potentially therapeutic-requires bleeding rate of at least 0.5 mL per minute

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73
Q

Pathway of oxalate kidney stones and Crohn’s

A

normally:
Oxalate is bound into calcium oxalate and the bound form is excreted in the stool

With Crohn’s:
steatorrhea and problems absorbing fat
the fat competes to bind calcium (leaving the oxalate free)

unbound oxalate reabsorbed by the colon and excreted by the kidney

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74
Q

treatment oxylate stone forming

A

calcium citrate

exatra calcium precipitates dietary oxalate

and citrate prevent stone formation and urine

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75
Q

syndrome of complete loss of adrenal function and potential cause

A

Waterhouse-Friderichsen syndrome is an adrenal gland hemorrhage that occurs after meningococcal sepsis infection

also described with pregnancy

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76
Q

lab findings with adrenal insufficiency

A

hyponatremia - lost aldo
HYPER kalemia -
Hypotension
fever

sometimes hypoglycemia - cortisol def

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77
Q

Gram negative bacteria cause of sepsis

A

ENDOtoxin

```
Lipid A
within lipopolysaccharide component
~~~

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78
Q

hemangioma CT finding

A

Peripheral enhancement

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79
Q

treatment of hemangioma

A

increased size
Symptoms
Kasabach-Merritt syndrome.- Consumptive heart failure

enucleation first choice

May require segment segmentectomy

NOT embolization

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80
Q

pressure the diagnosis portal hypertension

A

greater than 5

careful compared to IVC normal 0-5

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81
Q

portal pressure associated with esophageal variceal bleeding

A

–12

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82
Q

how is portal pressure calculated

A

difference between IVC and portal vein

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83
Q

best test to measure portal pressure and sinusoidal disease

A

e.g. cirrhotic

hepatic wedge

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84
Q

best test to measure portal pressure and pre-sinusoidal disease

A

EG schistosomiasis

wedge is not good-falsely low measurement

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85
Q

exam finding that differentiated AV fistula from pseudoaneurysm

A

thrill in CHF fistula

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86
Q

findings with popliteal entrapment

A

palpable pulses

Claudication with provocative activity

We progressed the paresthesias

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87
Q

Anatomic etiology of popliteal entrapment

A

develops in utero!

MEDIAL head of the gastroc
Or developmental problem popliteal artery

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88
Q

40-year-old smoking female string of beads on CTA left internal carotid

A

fibromuscular dysplasia of the carotid artery

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89
Q

symptoms of fibromuscular dysplasia of the carotid artery

A

TIA
Stroke
Disability

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90
Q

diagnosis of fibromuscular dysplasia of the carotid artery

A

ultrasound and CTA

possible angiogram

string of beads

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91
Q

treatment of fibromuscular dysplasia of the carotid artery

A

asymptomatic :
Antiplatelet therapy

Symptomatic:
Open - surgical dilation
or
angioplasty - gaining acceptance

NOT stent-redundancy kink, coil not amenable to this

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92
Q

most important muscles involved an active expiration

A 
rectus
Internal oblique
The external oblique
Transversus abdominis
Internal intercostal -   pull the rib cage down
 external intercostal
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93
Q

femoral hernia tissue repair

A

McVay (Cooper’s repair) approximate transversus abdominis aponeurosis to Cooper’s ligament

approach:
Incision ABOVE inguinal ligament
The external oblique aponeurosis split From external ring to internal ring-preserve ilioinguinal nerve

Open transversalis fascia
Hernia sac medial to the inferior epigastric vessels
Hernia sac freed from inguinal ligament

Medial:
Sutures placed pubic tubercle through transversus abdominis to Cooper’s ligament below

lateral:
Transition suture close femoral canal

Relaxing incision:
Anterior rectus sheath

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94
Q

treatment of fat emboli

A

immediate stabilization of fracture or long bones Decreases incident

supportive management:
May require intubation

Not proven:
Steroid in heparin

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95
Q

treatment of mesenteric obstruction and FAP patient with history of total domino proctocolectomy and ileoanal anastomosis

A

sulindac - anti-inflammatory medication decrease the size of desmoid tumor

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96
Q

LaPlace equation

A

tension = pressure x (radius / wall thickness)

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97
Q

2-year-old boy watery diarrhea, palpable mass on his right flank. elevated blood pressure and metanephrines in his urine. ataxia

A

nephroblastoma!

The

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98
Q

poor prognosticators of nephroblastoma

A

age or than one
Increasing neuron specific enolase
LDH
N-myc amplification

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99
Q

Findings that gives nephroblastoma better prognosis

A

hyperdilipoid
more DNA within tumor

more susceptible to chemotherapy

100
Q

palliation of unresectable pancreatic cancer

A

at endoscopic or PERCUTANEOUS transhepatic stent

Endoscopic BETTER results of your complications

Percutaneous reserved for patients with technical issues with endoscopy

metal stent longer lasting

Gastric outlet obstruction-second portion of duodenum

Duodenal obstruction-third or fourth portion and duodenum

Biliary obstruction:
Endoscopic expandable metal stent and duodenum

Not able to stent-gastro J.

pain refractory to narcotics:
Endoscopic or percutaneous celiac plexus block

101
Q

most common scenario her surgery is the approach taken to palliate pancreas cancer

A

undergoing laparotomy for anticipated resection and found to be unresectable

102
Q

most accurate diagnosis for renovascular hypertension

A

angiography!

Ultrasound is screening tool to assess flow velocities

MRI made over diagnosis

103
Q

indications for surgery of spontaneous pneumothorax

A

recurrence
Persistent leak
Incomplete expansion
High risk-high-pressure environment including air travel

104
Q

Berger disease

A

small and medium vessels

Tobacco worsens

Usual involves more than one digit

Initial treatment tobacco cessation

105
Q

ABI calculation and findings

A

ankle divided by brachial

higher of the 2 sides used

Dorsalis pedis and posterior tibial

Normal 1.0
claudication 0.7-0.9
Rest pain 0.4-0.7
Wound complications and gangrene/tissue lost LESS than 0.4

106
Q

cholangiocarcinoma risk factors, major prognosticator

A

primary sclerosing cholangitis

margin status

107
Q

treatment of cholangiocarcinoma

A

surgery only chance for cure

NO chemotherapy

108
Q

classification of cholangiocarcinoma

A 
#1  involves common hepatic duct
#2 hepatic bifurcation
#3 secondary hepatic ducts on one side
#4 tumors involved both side secondary hepatic ducts
109
Q

medial pectoral nerve

A

supply of both pectoralis major and pectoralis minor

110
Q

lateral pectoral nerve

A

supplies only pectoralis major

pectoralis major more lateral

111
Q

where anatomically does Zenker’s diverticulum develop

A

posteriorly
Transition zone between hypopharynx and esophagus-scalene triangle
Weakness near the cricopharyngeus muscle because from failure relaxation of upper esophageal sphincter

FALSE diverticulum

112
Q

shortness of breath and dyspnea on exertion. A chest x-ray shows a small calcified lesion in the right upper lobe that is new from previous films. The patient reports that he was recently on a hiking trip in Ohio

A

histoplasmosis

113
Q

treatment histoplasmosis

A

self limiting and do not require any further intervention!

careful, observe but These patients can have bulky mediastinal nodes that can cause compressive symptoms.

114
Q

course of the thoracic duct

A

originates at the cysterna chyli at L1-L2
courses superiorly on the RIGHT the AORTIC hiatus.
right of midline until
CROSSES to the left at T4-T5.
empties in to the LEFT subclavian vein at the junction with the IJV

careful, not brachiocephalic

115
Q

surveillance Peutz-Jegher syndrome

A

colonoscopy every 2 years

extracolonic cancers screening should begin at age 25

cervical and breast screening

other extracolonic cancers:
Thyroid
Lung

116
Q

timing of surgery for congenital diaphragmatic hernia

A

not emergent

Plan for date 2-3 of life the neonate is free of significant respiratory and cardiovascular compromise

117
Q

treatment of duodenal adenocarcinoma first or second portion of duodenum

A

Whipple resection

no chemoradiation

118
Q

Treatment of duodenal adenocarcinoma third or fourth portion of duodenum

A

segmental resection

no chemoradiation

119
Q

unstable patient esophageal perforation found to have cancer

A

cervical esophagostomy
gastrostomy
feeding J.

120
Q

Gold standard for AV fistula access

A

radiocephalic wrist-Cimino

anatomic snuffbox or just above the wrist crease

121
Q

that study to workup colovesicular fistula

A

CT scan
and demonstrate pneumaturia

but also needs colon
Endoscopy
Cystoscopy

122
Q

blood supply to the pancreas

A

celiac
Superior mesenteric artery
Splenic artery

123
Q

when is carotid endarterectomy not indicated

A

less than 50% stenosis

124
Q

indications for carotid endarterectomy

A

greater than 60% stenosis even asymptomatic

125
Q

size of ileal resection consistent with vitamin B12 problem

A

60 cm

126
Q

size ileal resection at risk for bile acid malabsorption

A

100 cm

liver cannot compensate with increased hepatic symphysis the bile-fat is not bound with bile sufficiently causing steatorrhea

127
Q

algorithm for workup of hemobilia

A

stable:
Endoscopy rule out other causes of upper GI bleed

Unstable high index of suspicion:
Angiography therapeutic and diagnostic

128
Q

Prior to dividing the gastrohepatic ligament at the right crus, what aberrant structure may be encountered

A

and accessory LEFT hepatic artery originating from the left gastric artery

careful, right crus region may have a LEFT accessory hepatic artery

129
Q

structures to be where of dissection around the right crus

A

LEFT vagus anterior
L APR
careful, right crus left anterior vagus

LEFT accessory hepatic artery and

130
Q

pyoderma gangrenosum

A

treatment steroids

Improved with resection of inflamed bile

Associated with inflammatory bowel disease

131
Q

and primary bile salts are conjugated where and by what

A

hepatocytes

GLYCINE

Taurine

132
Q

most common bacteria the colon

A

Bacteroides fragilis

Other anaerobes:
lactobacillus bifidus
clostridium
Eubacterium

Aerobe:
Escherichia coli- most common AEROBE
 Klebsiella
 Proteus
 Enterobacter
 enterococcus-Streptococcus faecalis
 careful,
133
Q

what helps platelet behind the endothelium

A

von Willebrand factor

134
Q

What helps platelet aggregate

A

thromboxane A2

other affect is vasoconstriction

135
Q

what cross-links platelets

A

thrombin

converting fibrinogen to fibrin

interval, cross-linking is not aggregation

136
Q

major inflammation stimulator for atherosclerosis

A

lipid core made from LDL

137
Q

at what point is compensatory arterial dilation no longer sufficient to compensate for percentage of stenosis from plaque

A

40%

careful, exertional angina not seen total 75% stenosis

138
Q

the role of Nissen fundoplication with Barrett’s esophagus

A

better than trying to maximize medical therapy

because there is continuation of reflux even if acid is controlled

139
Q

relationship of aortic arch and a thoracic duct

A

thoracic duct runs posterior to the arch

Originates at the cisterna chyli between T10 and L3 and enters the chest through the aortic hiatus to the right of the aorta and at T5, turns left and courses posterior to the aortic arch

courses anterior to the vertebral bodies between the aorta and the azygos vein and posterior to the esophagus

140
Q

mechanism of Cilostazol

A

Pletal

This is a phosphodiesterase III inhibitor
works on cAMP

Acts to:
inhibit smooth muscle so contraction and platelet aggregation

141
Q

mechanism of action of Pentoxyfiline

A

increases blood cell look stability

mechanism unknown

used to treat claudication on

142
Q

mechanism action of statin

A

HMG CoA reductase inhibitor

143
Q

drugs that inhibit cyclooxygnease

A

ASA

nonsteroidal anti-inflammatories

144
Q

mechanism of action of Plavix

A

irreversibly inhibited

adenosine diphosphate ADP
on platelet cell membrane

145
Q

only FDA approved treatment for claudication by medication

A

Cilostazol phosphodiesterase 3 inhibitor - decrease smooth muscle/decreased platelet aggregation

Pentoxyfinline - red blood cell flexibility

146
Q

findings of esophageal scleroderma

A

low amplitude
Simultaneous contractions
Normal lower esophageal pressure

careful, achalasia can have simultaneous contractions-difference is fail relaxation the lower esophageal sphincter

147
Q

treatment of esophageal scleroderma

A

treat underlying scleroderma and secondary symptoms of esophagus improve

methotrexate and immune modulaters

148
Q

diagnoses test of choice for blunt aortic dissection

A

TPA

149
Q

aortic Aneurysm of Marfan syndrome

A

aortic root!

risk of dissection

150
Q

defect in Ehlers-Danlos syndrome

A

collagen

151
Q

treatment of immediate postop intracranial embolism after carotid endarterectomy

A

thrombolytics

152
Q

inspiratory reserve volume

A

At the end of tidal volume inspiration

it is the maximum volume that can be inhaled from there

153
Q

expiratory reserve volume

A

from the end of title volume exhalation

the maximum amount of air that can be exhailed from there

154
Q

residual volume

A

volume air remaining in lungs after maximal exhalation

this includes a dead space

155
Q

total lung capacity

A

volume in lungs after maximal inflation

156
Q

inspiratory capacity

A

inspiratory reserve volume

AND tidal volume

157
Q

functional residual capacity - definition and calculation

A

the volume in lungs after normal exhalation

total lung capacity minus inspiratory capacity

or

expiratory reserve volume PLUS residual volume

158
Q

vital capacity

A

total lung capacity minus residual volume

159
Q

structures of the anterior compartment of the leg

A

extensor pollicis longus
Extensor digitorum longus
Tibialis anterior
Peroneal tertius

deep peroneal nerve
( careful, deep peroneal nerve not so deep - anterior compartment does not have tibial nerve)

ANTERIOR tibial artery

160
Q

nerve most commonly injured during lower extremity fasciotomy

A

superficial peroneal nerve

Superficial is at risk with - lateral incision - lies near the septum

located in the lateral compartment

161
Q

described for compartment fasciotomy

A

medial and posterior incision to the tibia:
decompresses superficial and deep posterior

lateral incision:
Intermuscular septum
decompresses anterior and lateral compartments

162
Q

defect with injury to superficial peroneal nerve

A

inability to evert foot

most commonly injured nerve during fasciotomy-lateral compartment

163
Q

defect was injury deep peroneal ulnar

A

FOOT DROP

unusual to injure during fasciotomy

164
Q

location of the deep peroneal nerve

A

ANTERIOR compartment

most commonly compressed nerve and compartment syndrome

165
Q

location and defect with tibial nerve

A

DEEP POSTERIOR compartment

166
Q

nerve and vessel and deep posterior compartment

A

tibial nerve

Posterior tibial artery

(careful, deep peroneal nerve is ANTERIOR compartment)

167
Q

most common organism for prosthetic graft infection

A

staph aureus

careful, no specific infection is staph epidermidis

168
Q

relationship of right hepatic artery to the common hepatic duct

A

right hepatic artery passes posterior to common hepatic duct as it heads towards the liver 85% of the time

169
Q

relationship of right replaced hepatic artery

A

to portal triad and

medial aspect of Calot’s triangle

POSTERIOR to CYSTIC duct

170
Q

first location of metastasis in the invasive gallbladder cancer

A

or cystic duct lymph nodes

171
Q

largest resistance and drop in blood pressure change of any vessel

A

arteriols

careful, not capillaries that are downstream - because surface area is so large and extensive network branching

172
Q

hereditary non-polyposis colon cancer special tumor characteristics

A

microsatellite instability
MLH1 MSH2 genes - these cause the:
DNA mismatch repair

173
Q

Amsterdam criteria

A

3 or more first degree relatives colon cancer

Across 2 generations
One member diagnosed prior to the age of 50

174
Q

associated with Lynch I

A

colon cancer

175
Q

associated with Lynch II

A

Cancer of :

endometrial
Ovarian
Gastric

176
Q

origin of the internal thoracic artery

A

first branch off subclavian

177
Q

tissue supplied by internal thoracic artery

A 
chest wall
Breast
Branches to
Thymus
Mediastinum
The sternum
178
Q

course of the internal thoracic artery

A

first branch off subclavian

Between the internal oblique and transverse thoracic muscles

Bifurcated sixth intercostal space

Muscular phrenic

Superior epigastric artery explanation mark

179
Q

cranial nerve innervated carotid body

A

cranial nerve 9

Branch of glossopharyngeal

180
Q

physiologic mechanism and responsive carotid body

A

edema receptor

Paraganglioma

Stimulated by:
Hypercapnia
Hypoxia
Decrease pH
Increase temperature
Signs none
Nicotine
 action:
Sympathetic stimulation
Increased heart rate
Increased vascular tone
Intracerebral cortical activity
181
Q

what do hepatocytes produced

A

bile
Synthesis proteins
Synthesis glucose

182
Q

Space of Disse

A

interaction between hepatocyte and blood

substances are exchanged via active transport

183
Q

recommended treatment for posterior knee dislocation and no flow past proximal popliteal artery on angiogram

A

bypass with CONTRALATERAL reverse saphenous vein

184
Q

the gallbladder his mechanism of bile concentration

A

ATPase dependent sodium chloride transport

185
Q

treatment of 2 cm common iliac occlusion

A

angioplasty and stent procedure of choice for all common iliac stenoses
less than 3 cm

186
Q

most common time period to develop aorto enteric fistula

A

2-6 years

187
Q

diagnostic modality that best demonstrates chance of cure and squamous cell carcinoma of the esophagus

A

EUS

EUS is better than PET

188
Q

most important prognosticators for esophageal cancer

A

depth of tumor penetration and node involvement

189
Q

indications on EUS the esophageal cancer his resectable

A

not invaded adjacent organs

Fewer than 5 enlarged lymph nodes

190
Q

when should screening begin with HNPCC

A

colonoscopy age 20 and all polyps removed

191
Q

recommend surgery for HNPCC colon cancer

A

total bowel colectomy with ileorectal anastomosis

or

female in no longer childbearing:
total abdominal hysterectomy and salpinco-oophorectomy

careful, FAP surgery is total abdominal proctocolectomy with ileal anal J-pouch

192
Q

extent of colon resection for cancer proximal to the hepatic flexure

A

right hemicolectomy:

Resect ileum approximately 5 cm proximal to the ileocecal valve

anastomosis to the first third of the transverse colon

take the right branch of the middle colic artery

also takes:
Ileocolic
Right colic

193
Q

mechanism action of pancreatic polypeptide

A

suppress:
bile secretion
gallbladder contraction
exocrine pancreatic function

194
Q

treatment of superior vena cava syndrome from multiple tunneled hemodialysis catheters

A

balloon angioplasty - first choice
( NOT embolectomy thrombectomy)

Often requires multiple interventions

Stents for now been tried - with some success

195
Q

percentage of gallstone ileus as the cause in an obstruction in patient older than 70 With no previous surgery and no hernias on exam

A

up to 25%!

196
Q

most common site of fistula and most common site of obstruction from gallstone ileus

A

duodenum

terminal ileum-most narrow

197
Q

epiphrenic diverticulum

A

pulsion diverticulum

distal esophagus

does not contain all layers of esophageal wall

198
Q

traction diverticulum

A

all layers of esophageal wall

midesophagus

199
Q

post thrombotic syndrome

A

23-60% of deep venous thrombosis

 edema
Pigmentation
Calf muscle dysfunction
Venous stasis ulcer
Valvular incompetence
Chronic venous insufficiency
200
Q

fibromuscular dysplasia pathophysiology and most common site of recurrence

A

most common site renal artery 80%

females 40-50-year-old

Medium-size arteries

MEDIAL most common

other less common sites:
Carotid artery
Iliac artery
Vertebral artery

201
Q

primary treatment of sliding hernia

A

type I hernia

PPI

202
Q

List order of prevalent of hiatal hernia

A

type I #1 most common
careful, type III SECOND most common
type II third most common

203
Q

structures at risk when dissecting posterior hiatal hernia sac in the mediastinum

A

left anterior vagus nerve

pleura, esophagus, and inferior pulmonary veins

204
Q

treatment of acute cholecystitis in patients who are too high a risk to undergo surgery including child’s C.

A

transit hepatic cholecystostomy

even in child C.

205
Q

where is the swallowing Center located

A

Medulla

same as breathing center

206
Q

risk of major limb amputation in patient with intermittent claudication per year

A

1% per year

207
Q

Severity of stenosis is categorized according duplex ultrasound

A

Less than 20% stenosis (NORMAL):

  • Velocities: 150 cm/sec
  • Waveform Characteristics: Spectral broadening throughout systole with no change in waveform
  • Management: Rescan in 6 months

50% to 75% stenosis (MODERATE):

  • Velocities: >180 cm/sec
  • Waveform Characteristics: severe spectral broadening in systole with reversed-flow components
  • Management: Rescan in 4-6 weeks; if lesion does not progress during two cycles of testing, increase scan interval to 3 months

Greater than 75% stenosis (SEVERE):

  • Velocities: >300 cm/sec
  • Waveform Characteristics: severe lumen reduction with a “flow jet”; damped distal velocity waveform
  • Management: Recommend repair (urgent if average PSV 0.15)
208
Q

primary functional bile acids

A

digestion of fat

209
Q

where are bile acid conjugated

A

hepatocyte:
Glycine
Taurine

Colon:
Bacteria conjugate primary bile acid into:
deoxycholic acid
lithocolic acid

210
Q

enzyme responsible conjugate primary bile acid

A

Glucoronyl transferase

211
Q

non gallstone reasons to perform cholecystectomy

A 
hydrops - Cystic duct obstruction
Biliary dyskinesia
 porcelain gallbladder ( but less concerned than patch were calcification)

NOT ascending cholangitis

212
Q

when do you start upper scope screening patients with FAP

A

age 20-25
OR
When colonic polyps first appear

213
Q

76-year-old female presents on post operative day #14 from a left femoral-popliteal bypass graft with PTFE with acute left lower extremity pain. You suspect that the graft has thrombosed.

Which is the MOST appropriate treatment for this patient?

A

Thrombectomy

with intra operative angiogram

214
Q

RCC that extends into the IVC

A

can be pulled out during the radical nephrectomy.

215
Q

AAA renal dysfunction perioperatively increased in

A

26-42% incidence

supraceliac clamping
Increased age
preoperative hypotension
prolonged clamp time

216
Q

described anatomy of right renal artery

A

medially below SMA L2
longer than the left as it courses POSTERIOR to inferior vena cava
posterior to renal vein
25-30% have accessory renal arteries

217
Q

surgical exposure required to access right renal artery

A

Kocher maneuver

Take down the right colon

218
Q

pigmentation pigmentation of bile

A

bilirubin diglucuronate

conjugated form

219
Q

primary source of bilirubin

A 
senescent red blood cells
 breakdown of heme
heme is converted to:
biliverdin
biliverdin is converted to:
 bilirubin
 bilirubin is taken up by hepatocyte:
 conjugated by glucuronic acid
220
Q

what gave his stool bile color

A

URObilinogen

this is because he did bilirubin from bacteria - and the amount not reabsorbed is passed in the stool

221
Q

effect of nitric oxide on platelet irrigation

A

INHIBITS aggregation

careful, vasodilation major factor

 in also:
Decreases inflammatory response
 decreases:
VACAM - 1
ICAM - 1
MCP - 1
222
Q

list the order of splenic aneurysms

A

splenic 60%
hepatic 20%
SMA 5.5%
celiac 4%

223
Q

treatment of pseudoaneurysm common femoral artery

A

greater than 2 cm:
Thrombin injection

 open repair:
 greater than 5 cm with wide neck
Overlying skin necrosis
 distal ischemia
Nerve compression
 active bleeding
224
Q

most common postoperative swelling of lower extremity bypass for chronic ischemia

A

lymphedema

generally improves over 2-4 months

225
Q

most common bacteria to cause lymphangitis and upper extremity

A

Streptococcus pyogenes

careful, other cause:
Staph aureus

226
Q

treatment of the iliac and femoral DVT in patient with swelling and extreme pain

A

thrombolysis - catheter directed

227
Q

superior mesenteric artery syndrome treatment

A

chronic:
duodenojejunostomy

not arterial bypass

Less common surgical treatments for SMA syndrome include Roux-en-Y duodenojejunostomy, gastrojejunostomy, anterior transposition of the third portion of the duodenum, intestinal derotation, and division of the ligament of Treitz.

acute:
Medical management
Pro-motility agents such as metoclopramide may also be beneficial

228
Q

etiology of superior mesenteric artery syndrome

A

compression of the third portion of duodenum between superior mesenteric artery and perivertebral musculature/vertebrae

If conservative treatment fails when reversed peristalsis persists,

229
Q

Factors that decrease the risk of PAD

A

HDL,
nitrous oxide
prostacyclins

230
Q

What is the MOST likely organism to be associated with a non-aneurysmal aortic infection

A

Salmonella

careful, STAPH is most common when associated with aneurysm

careful, STREP is most common when infection is to do bacterial endocarditis

231
Q

Most likely location for non-aneurysmal aortic infection

A

suprarenal

232
Q

postoperative intervention that had the most influence on vein graft patency

A

duplex ultrasound- improved patency by 15% when compared to clinical examination

Careful, Plavix is used not definitively proven for end result patency

233
Q

treatment of phlegmasia cerulea dolens

A

catheter directed thrombolytic can improve her outcome

The alternative for this condition is surgical venous thrombectomy.

No matter which treatment is chosen, long-term anticoagulation is indicated.

Careful, thrombectomy and systemic umbilicus have poor results

234
Q

Presentation of phlegmasia cerulea dolens

A 
complication and DVT-
arterial inflow can be compromised
Complete occlusion of the venous system
venous gangrene can develop unless flow is restored.
 edema and blistering with cyanosis

occasionally involve the trunk colon

235
Q

symptoms of vertebral artery stenosis

A 
dizziness
Vertigo
Tendinitis
Dysphagia
Dysarthria
Ataxia
236
Q

indications for treatment or vertebral artery stenosis

A

symptoms

237
Q

lymphedema precox

A

primary lymphedema

Occurs after puberty

238
Q

Lymphedema tarda

A

primary lymphedema

Recurred in women after the age of 35

239
Q

relationship of nitric oxide to LDL

A

nitric oxide inhibitor of LDL

240
Q

history of MI is what kind of perioperative risk

A

intermediate!

241
Q

physical diagnosis of Steal syndrome AV fistula

A

compressed graft relieve symptoms and returns radial pulse

242
Q

size of popliteal aneurysm requiring surgery

A

2.5 cm or greater - 30% symptoms in 3 years

ligate aneurysm as well the bypass

243
Q

strong risk risk factor for AAA

A

smoking

other risk factors:
MMP - damage to media and elastin
hypertension-infrarenal
age - decreased the last and

244
Q

Layer affected in AAA

A

tunica MEDIA

245
Q

presentation of occlusion of superficial femoral artery

A

thigh is still vascularized due to patent
femoral profundus!

discoloration of the knee and distally

246
Q

presentation of occlusion of the common femoral artery

A

cool lower extremity from 5 distally

May have waterhammer pulse or no pulse

QBANK MIX (28 decks)

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