Odds and Ends Flashcards
Approximately ___% of patients with upper GI hemorrhage have continued or rebleeding episodes. The mortality has remained the same over the past 20 years.
20%
LMW heparin is (more/less) effective than fractionated heparin in the prevention of DVT in high-risk individuals.
more
Why might an elevated INR in the posttraumatic setting not really have a protective effect for patients in terms of thromboembolism development?
It might just indicate coagulopathy induced by massive injury
Compare neuroblastoma vs Wilms tumor with regards to:
neuroblastoma: look sick, calcified, younger age group (<2), presurgical chemo, irregularly hyperechoic, extrarenal mass, crosses midline, elevated VMA and HMA, vascular encasement
Wilms: can look healthy, age 3-4, no calcification, marginated, evenly echogenic, intrarenal mass, does not cross midline
What are the stages of CRC and what are the treatments?
Stage 0: cancers have not grown beyond the inner lining of the colon, surgery to take out the cancer is all that is needed (polypectomy, or resection if tumor large)
Stage 1: These cancers have grown through several layers of the colon, but they have not spread outside the colon wall itself (or into the nearby lymph nodes). Partial colectomy — surgery to remove the section of colon that has cancer and nearby lymph nodes is tx
Stage 2: cancers have grown through the wall of the colon and may extend into nearby tissue. They have not yet spread to the lymph nodes; surgery with or without neoadjuvant chemotx (5-FU and leucovorin)
Stage 3: n this stage, the cancer has spread to nearby lymph nodes, but it has not yet spread to other parts of the body. Surgery (partial colectomy) followed by adjuvant chemo is the standard treatment for this stage. Either the FOLFOX (5-FU, leucovorin, and oxaliplatin) or CapeOx (capecitabine and oxaliplatin) regimens are used most often. Possible radiation therapy
STage 4: The cancer has spread from the colon to distant organs and tissues. Chemo is typically given as well, before and/or after surgery. In some cases, hepatic artery infusion may be used if the cancer has spread to the liver.; palliative surgery
What imaging is used to document acute osteomyelitis?
Radionuclide
Risk-benefit analysis has demonstrated that surgery benefits ouweigh the risks when colectomy is performed after what number bout of diverticulitis?
fourth bout
Squamous cell carcinoma of the esophagus is highly sensitive to
radiation therapy
When is primary esophageal repair in esophageal perforation?
If the perf is less than 24 hours in duration
If the patient is in good physiologic condition, surgical repair is used regardless of duration of perf
Though biliary colic is most commonly produced by the mechanical obstruction of gallbladder drainage by a gallstone, in a small subset of patients, it can be unrelated to gallstones. This condition is called:
bilary dyskinesia (gallbaldder ejection fraction
Gallbladder dysfunction in patients with biliary dyskinesia can be visualized with
a HIDA scan following CCK administration
Hyperparathyroidism is associated with which electrolyte abnormalities?
high calcium/calcinuria, low serum phosphate, high serum chloride, low serum bicarb
(PTH decreases bicarb reabsorption, chloride compensates)
OPSS is more liekly to occur in (children/adults) and in patients who had splenectomies for (trauma/primary hematological disorders).
Children; primary hematological disorders
Which patient group with ITP responds the best to splenectomy?
Those who responded to corticosteroid therapy
What is the most common liver mass?
hemangioma
Which measurement of depth is better at staging melanoma: breslow or clark?
Breslow
For a melanoma wiht depth between 2 and 4 mm, what are adequate margins?
2-3 cm
What is the only way to diagnose biliary atresia?
Operative exploration and intraoperative cholangiogram. However, it is not uncommon for patients with biliary hypoplasia (Alagille syndrome, which may include bile duct paucity or absence) to have no excretion of tracer into the duodenum on HIDA scan
What is Alagille syndrome?
bile duct paucity or absence; AD inheritance. Other signs of Alagille syndrome include congenital heart problems (ToF), an unusual butterfly shape of one or more of the bones of the spinal column that can be seen in an x-ray, certain eye defects, and narrowed pulmonary arteries that can contribute to increased pressure on the right heart valves.
In patients with biliary kinesia after 120 days, ___________ is rarely indicated.
Kasai portoeneterostomy (transplant instead)
A ductogram showing a well-filled duct except for a solitary lobulated filling defect is more consistent with _________
intraductal papilloma
What are type 5 gastric ulcers?
associated with chronic NSAID or aspirin use (can occur throughout the stomach)
T/F: The presence of ascites is a contraindication to Whipple surgery.
True. Ascites likely indicates poor hepatic reserve or disseminated cancer.
