More ABSITE Questions Flashcards
Cameron’s Lesions
Chronic blood loss as a result of mechanically induced linear erosion at the level of diaphragm within the hiatal hernia
Where can GI hyperplastic polyps be found?
anywhere in the GI tract; they have low GI malignant potential
What is considered an abnormal Gastric emptying study?
When > 60% of contents at 2 hours, or >10% at 4 hours
What do you do in a Bilroth 2 patient with gastroparesis
Total gastrectomy!
What do you do for a type 2 and 3 gastric ulcer
Antrectomy and vagotomy
Do you get reflux in B2 patients?
Yes, d/t defective pyloric channel, leading to itnestinalization of the gastric mucosa. No ulcers
What vessel do you need to preserve in a subtotal gastrectomy?
LEFT gastroepioploic (right gets saved in a esophagectomy)
What is early dumping syndrome d/t?
Osmotic load (late is d/t carbs rushing into the duodenum, causing a surge of insulin causing overcompensate causing hypoglycemia
What is the most predictive index for GIST tumors?
mitotic index
How do GIST tumors spread
Hematogenous
Is PET good for gastric cancer?
No. 50% PET avid
What are the risk factors for stress gastritis?
Coagulation, prolonged ventilation
What are the 3 types of gastric carcinoids?
- Type 1- chronic gastritis and pernicious anemia
- MEN1 and ZES, small
- Large, aggressive
What are the stages of GIST?
Stage 1A- < 5cm;
Stage 2 <5cm with high mitotic rate or > 10cm
Stage 3A- 5-10cm with high rate
Stage 3B- 10cm with high mitotic
What type of surgery for BCC?
Mohs
What margins for melanoma
0.5mm in face
What rx do you give for metastatic melanoma?
Dacarbazine
When do you do incisional vs excisional bx for sarcoma?
4cm
How do you treat malignant sarcoma?
Doxorubicin
How do you treat keloids?
Lidocaine/triamcinolone injection into the scars
Topical anti-inflammatory with silicon sheet
What is the standard scalp reconstruction?
Lat dorsi flap
What is the most common melanoma?
Superficial spreading
What is the most aggressive melanoma?
Nodular
Which melanoma is the least malignant?
Lentigo maligna
Features of dermatofibroma sarcmoa
Lateral tentacles CD34 Low grade High risk of recurrence 2cm block excision
What are the Hurley stages for Hiradenitis suppurativa
- Abscess
- Recurrent abscess, sinus tract and scarring
- Diffuse
What is the modified Brook formula for fluid resuscitation?
TBSA x weight (kg) x 2
How do you treat esophageal leiomyoma?
NO BX! scarring
Resect it. It is benign
Endoscopic repair is <5cm, otherwise VATS
How much esophagus do you want in the abdomen?
2-3 cm, otherwise need a Collis
What type of incision do you make for a mid esophageal perforation?
Right POSTEROLATERAL
What does esophagus dimpling indicate on imaging
Hiatal hernia
Is there help with mesh for hiatal hernia?
Short term outcomes show improvement, but no long term improvement
What do you save for a Ivor Lewis?
RIGHT GEA
What cancer treatment do you use for esophageal?
Cisplatin and 5FU
How do you repair Zenker in a patient with cervical stenosis?
Open repair (less than 2cm diverticulectomy. If larger, remove sac with myotomy)
How much should you dilate the esophagus during dilations to avoid perf
No more than 2mm per session
What is Borchardts triad
Severe epigastric pain, inability to vomit, can’t pass a NG
For a hiatal hernia and dysmotility what type of repair do you do?
Dor
Where is esophageal perf occur?
Cricopharyngeus,
Instrumental also at distal esophagus
For prior gastric surgery but have reflux and need surgery, what type of surgery?
Hill esophagogastropexy
How much time must pass frmo time of catheter removal before rivaroxaban can be restarted?
6 hours (otherwise 3 days if pain control)
What is the risk of an anterior scalene nerve block? What sx do you see
Phrenic nerve (travels over the surface of the anterior scalene)
SOB d/t hemidiaphragm
Why does total spinal anesthsia occur?
Result of excessive cephalic spread of local anesthetic
What is the early sign of local toxicity of anesthetic?
Neuro sx- ringing in ear, pica, confusion
What does a severe drop in CO2 during OR mean?
Extubation, disconnection, or cessation of CO like d/t CO2 embolism
How do you traet a CO2 embolus?
Stop insufflation, position to push CO2 to prevent right ventricle, ventilate
What anesthetic spray can cause methemoglobinemia?
Benzocaine
“chocolate brown” arterial blood.
Pulse ox is not reliable
When wuld you not use NO?
closed spaces, like SBO or PTX
What is ASA Class 2?
Mild systemic disease- controlled HTN or D, smoking
What is ASA Class 4?
Severe constant threat to life
What is the pathology of mucinous cystic neoplasm?
Ovarian type stroma
What is a consequence of short gut syndrome with NEC?
Dependence of TPN, leading to cholestatic hepatic dysfunction
What do you do about incidental intusseption?
Nothing to do
What is associated with an absent vas deferens?
Cystic fibrosis
How do you treat H type TE fistula?
Right cervicotomy
How do you treat jejunal atresia?
Differently. Preserve bowel length and avoid short gut
What is associated with complex gastroschisis?
Stenosis, intestinal atresia, perforation, volvulus
DO you operate on a ped appy overnight?
No, wait and resuscitate until the morning. Better outcomes and lower risk of abscess formation
Repair a hernia when?
> 24 hours later because of the associated swelling and risk of missing a direct hernia
How do you treat a patent omphalomesenteric duct?
Elective resection
What medical imaging do you use for a HDS malro kid?
Upper GI series with contrast
What is PTLD
post transplant lymphoproliferative disorder.
over expression of EBV, development of lymphomas in transplant patient.
- Reduce immunosuppressive regimen
- nd line rituximab and or CHOP
No surgery
Treatment of Zenker’s
Diverticulectomy <2cm
ectomy and myotomy for good surgical patients.
Pexy and myotomy for moderate size.
<2 pexy or myotomy alone
What is teh most common location for ectopicsuperior parathyroid?
TE groove
Ectopc inferior parathyoid?
thyrothymus
Missed adenoma of parathyroid?
TE groove
Missed parathyroid?
Normal anatomy
When would you do an emergent thoracotomy time wise?
< 10 minutes prearrival
How long of CPR before pronounce?
20 minutes
What is type 1 hepatorenal syndrome
Acute, doubling of Cr in < 2 weeks, has a precipitating event, no history of diuretic resistant ascited, 10% survive without traetment
IABP
intra aortic balloon pump, placed when a reduced EF. It reduces preload nad afterload, improving myocardial perfusion, thereby improving cardiac output
What volume do you use for ARDSnet/ prevention
6mL/kg during ventilaton
What heart rhythms require defibrillation
V fib and V tach
What type of cancer in undescended testicles?
Seminoma
What is the gold standard for imaging choledochal cyst
MRCP
What are worrisome features for pancreatic ca?
Jaundice, enhancing solid component and MD > 1cm
For male breast cancer, when do men get chemo?
if cancer > 5mm
Radial scars architecture
Fibroelastic core that pulls and distorts ducts and lobules
Find linear pleomorphic microcalcifications
DCIS
What other cancer is BRCA1 associated with
high occurrence of medullary cancer
What LN levels for ANLD?
Zone 1 and 2
What will Phyllodes stain as
Vimentin and actin because of fibrous and stromal componenets
Children 20-40
D/t bacterial, parasite, fungi; MCC Staph/Strep pyo
Fluctuant mass, with normal TFTs
Do FNA and cx and if abscess/pyriform sinus fistula present, surgical drainage may be indicated
Acute suppurative
What is loss of opposed phase chemical shift in MRI for adrenal
Cortical adenoma (d/t intracellular lipid). Carcinoma does not lose signal
When do you convert from lap to open adrenalectomy
> 6-8cm
What age groups are at risk for thyroid cancer
Young and old
What does lithium do to parathyroid
4 gland parathyroid hyperplasia
What differentiates T1 vs T2 adrenal cancer?
5cm
How does myxedema coma present
hypothyroid, hypocortisol, hypoventilation, hypothermia, hypoglycemia, infection
How does secretin stimulation test work
Causes an icnrease in gastrin levels > 120 pg/mL over basal levels
When to give mitotane
R1 resection, invasion into vascular or capsule, intraoperative tumor spillage
MCC cancer in transplant
Squamous
How doyou determine urine Cr?
MAG-3 or urine creatinine
S/e of mycophenolate
GI, GIB, pancytopenia
nivolumab
PD-1
caspofungin mech
D-glucan, used for g glabrata
CAH patients watch out for what?
testes nodules, adrenal tissue
What is renal lac grades
Grade 2- parenchyma, Grade 3- medulla, Grade 4- collecting duct
What do you watch out for resecting the kidney/adrenal
tail of panc
How do you repair ureter injuries b/w the UPJ and pelvic braim
Ureteroureterostomy
When dont ing data is sufficientyou need liver bx
Lab and imag
R/f for HCC
A1AT deficiency, excessive androgen use, HFE, vinyl chloride, aflatoxin
MCC of Budd Chiari
myeloproliferative d/o
How do you treate hytadid cyst
Albendzaole
What are the borders of the foramen of winslow
duodenum inferior, liver superior, IVF posterior, and portal triad anterior
Petit triangle
EO, lat, iliac rest
BNSIM obturator hernia
Operate. 50% are SBO.
Rec for deep cuff placement of PD catheter
Placement of the deep cuff in the muscle allows for tissue ingrowth and strong fixation of the catheter
HIPEC drugs
Cisplatin, doxorubicin, mitomycin C
What prevents radiation injury to the bowel
Amifostin
What is blind loop
Loops of intestine bypassed by enteroenteric fistulas, may stagnate and proligerate backteria leading to malabsorption symtpoms of B12 and steatorrhea
What does radiation enteritis look like
Pale, friable mucosa with telangietcasis
Where do ureters get damaged
at level of uterine artery
What do you need for previable fetus
just pre and post op fetal heart tracings
tx for cervical cancer
TAH; add cisplatin/paclitzel if greater than IIb
Sx of essential fatty acid deficiency
dermatitis, alopecia, patchy red areas of skin, brittle nails, bruising, delayed wound healing
what does resp quotient > 1 mean
excessive feeding, more CO2 prodction, likely hard to get off vent
Intragastric feeding- what group NOT to give
head trauma. gastroparesis results
What is caloric requirement for burn patients
25 kcal/kg/day + (30 x % burn)
Calculate nitrogen balance
protien/6.24 - (UUN + 4)
Grades of HTN
Grade 1- 12-15mmHg, Grade 2 16-20mmHg, nonsurgical management.
NPO, gut ecompression wiht NG, limit NG
Grade 3 and 4 above 20mmHg require laparotomy decompression
Ti NE tumors
Right hemicolectomy
large bowel stricture management
RESECTION!
risk of malignancy
