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zAbsite Final 2019 > Old deck > Flashcards

Old deck Flashcards

1
Q

<p>Tx of SIADH</p>

A

<p>fluid restriction</p>

<p>demeclocycline or vaptans (adh inhibitor)</p>

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2
Q

<p>Portal vein thrombosis tx</p>

A

<p>Control HMHG with variceal ligation</p>

<p>Anticoagulate once bleeding controlled</p>

<p>Consider distal spleno-renal shunt</p>

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3
Q

<p>MRSA tx</p>

A

<p>vancomycin</p>

<p>if vanc resistant then linezolid</p>

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4
Q

<p>VWF</p>

A

<p>binds GP1b on PLTs and attaches them to endothelium</p>

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5
Q

<p>Margin for invasives cancer vs. dcis</p>

A

<p>invasive cancer- gross negative</p>

<p>dcis- 1 to 2 mm</p>

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6
Q

<p>Interleukins 1, 2, 4</p>

A

<p>IL1: fever</p>

<p>IL2: T cell prolif and Ig production</p>

<p>IL4: T/B cell maturation</p>

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7
Q

<p>Ovarian tumor markers:</p>

<p>AFP</p>

<p>CEA</p>

<p>HCG</p>

<p>LDH</p>

<p>Ca 125</p>

<p>Inhibin</p>

A

<p>AFP: yolk sac tumor, endodermal sinus</p>

<p>CEA: mucinous ovarian tumor</p>

<p>HCG: ovarian choriocarcinoma, embryonal carcinoma</p>

<p>LDH: dysgerminoma</p>

<p>Ca 125: epithelial ovarian tumors</p>

<p>Inhibin: granulosa cell tumor</p>

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8
Q

<p>Hormones that increase LES pressure</p>

A

<p>Gastrin</p>

<p>Motilin</p>

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9
Q

<p>Origin of med thyroid cancer</p>

A

<p>4th pharyngeal arch NCC --> parafollicular C cells</p>

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10
Q

<p>Gardner syndrome</p>

A

<p>epidermal cysts, GI polyposis, osteomas</p>

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11
Q

<p>Indidcations for operative treatment of eso perf</p>

A

<ul> <li>early postemetic perforation</li> <li>hemodynamic instability</li> <li>intra-abdominal perforation</li> <li>extravasations of contrast into adjacent body cavities</li> <li>presence of underlying malignancy, obstruction or stricture</li></ul>

<p>place jejunostomy tube for feeding after. don't place gastric tube (conduit)</p>

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12
Q

<p>Uremic PLT dysfunction</p>

A

<p>2/2 renal disease</p>

<p>reversible dysfunction</p>

<p>tx- ddavp</p>

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13
Q

<p>B12 def</p>

A

<p>megalo anemia, neuropathy</p>

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14
Q

<p>Traction vs. Pulsion Diverticulum</p>

A

<p>traction- inflammation; all 3 layers; mid eso</p>

<p>pulsion- pressure; 2 layers; above circoph.</p>

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15
Q

<p>Positioning for indirect laryngoscopy</p>

A

<p>sitting upright with a straight back, leaning slightly toward you with chin pointing upward (“sniffing position”)</p>

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16
Q

<p>Kcal per macronutrient</p>

A

<p>protein = 4 kcal/g</p>

<p>dextrose = 3 kcal/g</p>

<p>lipid = 9kcal/g</p>

<p>carb = 4 kcal/g</p>

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17
Q

<p>p53</p>

A

<p>TSG on Ch17</p>

<p>cell cycle regulation and apoptosis</p>

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18
Q

<p>Rule of 9s</p>

A

<p>Each arm 9</p>

<p>Each leg 18</p>

<p>Ant belly 18, Post belly 18</p>

<p>Each hand 1</p>

<p>Ant face 4.5, Post face 4.5</p>

<p>Genitals 1</p>

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19
Q

<p>EBV associated with</p>

A

<p>B cell lymphome (Burkitt)</p>

<p>n/ph cancer</p>

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20
Q

<p>FRC</p>

A

<p>Volume of the lung after normal tidal expiration</p>

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21
Q

<p>Cisatracurium</p>

A

<p>non-depolarizing</p>

<p>cleared by Hoffman degradation</p>

<p>use in pts w/ renal and hepatic disease</p>

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22
Q

<p>tacro</p>

A

<p>MOA: calcineurin inhibitor (binds fK)</p>

<p>s/e- nephrotoxic, p. neuropathy, allopecia</p>

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23
Q

<p>SD</p>

A

<p>1, 2, and 3 SD = 67%, 95%, and 99.7% of the data</p>

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24
Q

<p>Intraductal papilloma</p>

A

<p>MCCO bloody nipple d/c</p>

<p>tx w/ duct excision</p>

<p>no increased r/o ca</p>

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25
Q

<p>Blood supply to esophagus</p>

A

<p>Upper 3rd- inferior thryoid artery</p>

<p>Middle 3rd- thoracic aorta</p>

<p>Lower 3rd- left gastric</p>

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26
Q

<p>Pleomorphic adenoma</p>

A

<p>MC benign H/N tumor</p>

<p>middle aged woman</p>

<p>slow growing; t2 bright</p>

<p>Tx: superficial parotidectomy even if asx</p>

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27
Q

<p>Rule of 6s</p>

A

<p>flow > 600/min</p>

<p>diameter > 6mm (after placement)</p>

<p>depth of 6mm</p>

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28
Q

<p>Comparing pressors</p>

A

<p>Norepi: alpha1 >alpha2,beta1</p>

<p>Epi: beta1, alpha1 > beta2, alpha2</p>

<p>Phenylephrine: alpha1 > alpha2(no beta)</p>

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29
Q

<p>MCCO of spontaneous bacterial peritonitis</p>

A

<p>E. Coli</p>

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30
Q

<p>Max dose of lido and bupiv</p>

A

<p>lido = 5mg/kg (7 w/ epi)</p>

<p>bupiv = 2.5 mg/kg</p>

<p>tx- lipid emulsion</p>

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31
Q

<p>Lamivudine</p>

A

<p>rTranscriptase inhibitor</p>

<p>Tx for hep B at low doses; HIV at high doses</p>

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32
Q

<p>Wound healing order of entry</p>

A

<p>plts → PMNs → macrophages → fibroblast → keratinocytes</p>

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33
Q

<p>5Ts of cyanosis</p>

A

<ol> <li>TOF</li> <li>Transposition of GVs</li> <li>Truncus art</li> <li>Tricuspid atresia</li> <li>TAPVC</li></ol>

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34
Q

<p>Pain after inguinal hernia repair</p>

A

<p>Ilioinguinal nerve</p>

<p>Injured at external ring. Lies anterior to cord</p>

<p>tx- local injection</p>

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35
Q

<p>Staging adrenal cancer</p>

A

<p>s1- <5cm</p>

<p>s2- >5cm</p>

<p>s3- n1 or t3</p>

<p>s4- mets</p>

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36
Q

<p>location of vagus nerve</p>

A

<p>LARPleft anterior, right posterior to esophagus</p>

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37
Q

<p>Dopamine dosing</p>

A

<p>low- d1/2 ago (renal dose)</p>

<p>medium- B ago</p>

<p>high- A ago</p>

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38
Q

<p>LIPID A</p>

A

<p>Gram negative bacteria (Klebsiella)</p>

<p>lipopolysaccharide layerendotoxin → septic shock</p>

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39
Q

<p><span>Beta lactamase inhibitors</span></p>

A

<p><span>Sulbactam/Tazobactam</span></p>

<p><span>Clavulanic acid</span></p>

<p></p>

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40
Q

<p>Contents of ant triangle</p>

A

<p>Carotid sheath, anca cervicalis, CN 12 (hypoglossal)</p>

<p>Contents of carotid sheath: CN10 (vagus), CCA, ICA, internal jugular</p>

<ul> <li>facial vein is the gateway</li></ul>

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41
Q

<p>BRCA risks</p>

A

<p>female breast, ovarian, male breast</p>

<p>I- 60, 40, 1</p>

<p>II- 60, 10, 10</p>

<p>Women withBRCAbreast CA have the same prognosis stage for stage as non-BRCAbreast CA</p>

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42
Q

<p>Kasabach-Merritt Syndrome:</p>

A

<p>hemangioma + thrombocytopenia</p>

<p>usually infants</p>

<p>resect!</p>

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43
Q

<p>Traumatic renal artery thrombosis</p>

A

<p>Unilateral- anticoagulation</p>

<p>Bilateral- OR or IR stent</p>

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44
Q

<p>Adenoid cystic carcinoma</p>

A

<p>MC minor salivary gland tumor (SM gland)</p>

<p>propensity for perineural invasion</p>

<p>Remains quiescent for years then metastasizes aggressively</p>

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45
Q

<p>SLNBx for melanoma</p>

A

<p>< .75 mm none</p>

<p>> .75 to 1 mm w/ ulceration, mitosis, invasion</p>

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46
Q

<p>Hernia repairs:</p>

<p>Bassini</p>

<p>McVay</p>

<p>Lichtenstein</p>

A

<p>Bassini: CT to IL</p>

<p>McVay: CT to cooper's</p>

<p>Lichtenstein: mesh</p>

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47
Q

<p>Casues of increased ETCO2</p>

A

<p>Increased muscle activity (shivering)</p>

<p>Increased metabolism (sepsis, fever, malignany hyperT)</p>

<p>Increased CO</p>

<p>Decreased minute ventilation</p>

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48
Q

<p>Acute cellular rejection</p>

A

<p>T cell mediated</p>

<p>path: portal cellular infiltrate + endotheliitis</p>

<p>tx: pulse steroids → consider thymo</p>

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49
Q

<p>Phyllodes tumor</p>

A

<p>“sarcoma of the breast”</p>

<p>tx- en bloc resection</p>

<p>hematog spread- chemo/LN dissection unnneccesary</p>

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50
Q

<p>Birads 0</p>

A

<p>More imaging: mammogram or targeted US</p>

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51
Q

<p>Mediastinal tumors</p>

A

<p>Anterior: lymphoma MC in children, thymoma MC in adults</p>

<p>Middle: lymphoma MC</p>

<p>Posterior: neurologic MC</p>

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52
Q

<p>Vitamin C</p>

A

<p>hydroxylation of lysine and proline</p>

<p>type 3 collagen cross-linking</p>

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53
Q

<p>Staph virulence factors</p>

A

<ol> <li>protein A: binds Fc component of IgG, forcing variable region to face away from bacterium</li> <li>Enterotoxins: intestines</li> <li>Toxic shock syndrome toxin-1 (TSST-1): superantigen. binds MHC II and T-cell receptor</li> <li>Coagulase: converts fibrinogen to fibrin clot</li> <li>Exfolatins: skin-exfoliating toxins</li></ol>

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54
Q

<p>CN11</p>

A

<p>spinal accessory nerve</p>

<p>exit jugulars foramen</p>

<p>innervates SCM and trapezius goes along post triangle</p>

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55
Q

<p>Tx of SVC syndrome</p>

A

<p>Angio stenting and steroidsfor sxatic relief</p>

<p>Urgent chemo/rads therapy</p>

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56
Q

<p>Silvadene, mafenide, silver nitrate s/e</p>

A

<p>Silvadene: s/e- neutropenia, hypersensitivity, kernicterus (avoid in preg)</p>

<p>Mafenide: psuedomonas coverages/e- met acidosis</p>

<p>Silver Nitrate: s/e- hypoNatremia</p>

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57
Q

<p>Indications for radioiodine thereapy</p>

A

<p>2-4 cm mass</p>

<p>vascular invasion</p>

<p>anti-Tg Ab</p>

<p>TG < 5</p>

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58
Q

<p>Hemophilia A</p>

A

<p>f8 DEFICIENCY SLR</p>

<p>MC inherited disorder</p>

<p>tx- DESMOPRESSIN (mild), f8 concentrate (severe)</p>

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59
Q

<p>Strongest layer of bowel</p>

A

<p>SM</p>

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60
Q

<p>Contents of post triangle</p>

A

<p>CN 11 subclavian artery</p>

<p>EJV</p>

<p>brachial plexus trunks</p>

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61
Q

<p>Paget-Schroetter syndrome</p>

A

<p>Exercise induced thrombosis of subclavian/axillary VEIN</p>

<p>Tx- catheter directed thrombolysis</p>

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62
Q

<p>NEC</p>

A

<p>Bloody stools after 1st feed</p>

<p>dx- pneumatosis</p>

<p>tx- resuscitation, abx; OR if free air, clinical deterioration</p>

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63
Q

<p>Fibroadenoma</p>

A

<p>cyclical pain</p>

<p>dx- US guided core bx</p>

<p>only excise if discordance with biopsy!</p>

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64
Q

<p>Pancuronium</p>

A

<p>non-depol</p>

<p>eliminated by kidney and liver</p>

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65
Q

<p>Location ofsuperior sympathetic block</p>

A

<ul> <li>3 to 5 cm in length</li> <li>on the longus capitus muscle</li> <li>anterior to the transverse process of the second, third, and rarely the fourth cervical vertebrae</li></ul>

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66
Q

<p>Order of contents in thoracic outlet</p>

A

<p>vein (SC)</p>

<p>phrenic</p>

<p>muscle (scalene)</p>

<p>artery (SC)</p>

<p>nerve (br plexus)</p>

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67
Q

<p>Insulinoma</p>

A

<p>Loc: throughout</p>

<p>Px: whipple's triad</p>

<p>tx- < 2cm encucleate, >2cm resect</p>

<p></p>

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68
Q

<p>GCS verbal</p>

A

<p>5- normal</p>

<p>4- confused</p>

<p>3- inappropriate words</p>

<p>2- incomprehensible</p>

<p>1- none</p>

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69
Q

<p><span>Plasmin</span></p>

A

<p><span>Degrades f5, 8, fibrinogen, and fibrin</span></p>

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70
Q

<p>TXA2</p>

A

<p>vasoconstrictors</p>

<p>released by PLTs</p>

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71
Q

<p>Pseudocyst</p>

A

<p>encapsulated</p>

<p>lack epithelial lining</p>

<p>>5cm requires drainage</p>

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72
Q

<p><span>Sevoflurane</span></p>

A

<p>fast, less laryngospasm, less pungent</p>

<p>good for mask induction</p>

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73
Q

<p><span>Fibrin</span></p>

A

<p><span>Links Gp2b/3a to form PLT plug</span></p>

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74
Q

<p>NOAC reversak</p>

A

<p>Dabigatran (pradaxa)- Idarucizumab, iHD</p>

<p>Apixaban- PCC (partial)</p>

<p>Rivoroxaban- PCC (partial)</p>

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75
Q

<p>Indications for post op radio-iodine</p>

A

<p>2-4 cm</p>

<p>vascular invasion</p>

<p>anti-Tg Ab</p>

<p>TG<5</p>

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76
Q

<p>PEAK and TROUGH</p>

A

<p>PEAK- amount</p>

<p>TROUGH- frequency</p>

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77
Q

<p>Desmoid tumor</p>

A

<p>Locally aggressive with no portential for mets</p>

<p>Tx with resection and chemo</p>

<p></p>

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78
Q

<p>MC vitamind def after REY GB</p>

A

<p>B12</p>

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79
Q

<p>Ulcers:</p>

<p>Marginal</p>

<p>Cameron</p>

<p>Marjolin ulcer</p>

<p>Cushing's ulcer</p>

A

<p>Marginal- REYGB at GJ anastomosis</p>

<p>Cameron- on lesser curve of large hiatal hernia</p>

<p>Marjolin ulcer- chronic wound</p>

<p>Cushing's ulcer- elevated ICP</p>

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80
Q

<p>Products of posterior pituitary</p>

A

<p>"PAO in the POST"</p>

<p>ADH, Oxytocin</p>

<p>2/2 direct stem from neurosecretory cell</p>

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81
Q

<p>Stage 3 breast cancer and tx</p>

A

<p>3a- 4 to 9 nodes --> consider neoadj for BCT</p>

<p>3b- chest wall (not pec wall) or breast skin --> neoadj required</p>

<p>3c- supra clavicular nodes --> neoadj required</p>

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82
Q

<p>Tx of GIST</p>

A

<p>Resection w/ gross margin</p>

<p>No LN dissection</p>

<p>Add imatinib (TK inhibitor) if >5m/50HPF</p>

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83
Q

<p>Non-cyanotic heart defects</p>

A

<p>ASD</p>

<p>VSD</p>

<p>coarctation</p>

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84
Q

<p>Bevacizumab</p>

A

<p>recombinant humanizedmonoclonal antibodythat blocks angiogenesis by inhibitingVEGF-A</p>

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85
Q

<p>c/i to BCT</p>

A

<p>multicentric</p>

<p>inflammatory ca</p>

<p>c/i to radiation</p>

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86
Q

<p><span>AT3 Functions</span></p>

A

<p><span>Inhibits thrombin2. Inhibits f9, 10, 11</span></p>

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87
Q

<p>Ranson's criteria on admission</p>

A

<p>"GA Law"</p>

<ol> <li>Glu > 200</li> <li>age > 55</li> <li>LDH > 350</li> <li>AST > 250</li> <li>WBC > 16</li></ol>

<p></p>

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88
Q

<p>Cholangiocarcinoma types</p>

A

<p>1- below confluence</p>

<p>2- at confluence</p>

<p>3- R or L hep duct</p>

<p>4- R and L hep duct</p>

<p>5- multicentric</p>

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89
Q

<p>Glycogen</p>

A

<p>stores depleted after 24-48h of starvation</p>

<p>MOST found in skeletal muscle, rest in the liver</p>

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90
Q

<p>Types of esophogectomy</p>

A

<p>Transhiatal- laparotomy and cervical incision/anast</p>

<p>Ivor Lewis- thoracic incisions/anast</p>

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91
Q

<p>type 3 choledochocal cyst</p>

A

<p>choledochocele</p>

<p>tx- transduodenal marsupialization or excision</p>

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92
Q

<p>Treatment of colo-cutaenous fistula</p>

A

<ul> <li>Start with conservative tx</li> <li>High output: > 500 cc/day --> likely OR</li> <li>Low Output: < 200 cc/dayt --> likely conservative</li> <li>OR if failed after about 6 weeks</li></ul>

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93
Q

<p>CPP</p>

A

<p>MAP - ICP</p>

<p>normal CPP > 60</p>

<p>Normal ICP < 20</p>

<p>hyperventilation to 35 decreases CO2 causing vascoconstriction and decreasing ICP</p>

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94
Q

<p>Accessible nodal stations w/ EBUS</p>

A

<p> 2, 3, 4, 7, 10, 11, 12</p>

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95
Q

<p>tx of Meckels</p>

A

<p>tx- resection if sxs.</p>

<ul> <li>if appendicits leave Meckel's alone</li> <li>If no appendicitis take out the Meckel's</li></ul>

<p>Only consider taking out incidentally found asx Meckel's in young/healthy pt</p>

<p>if bleeding, inflamed or tumor at base --> segmental resection</p>

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96
Q

<p>Hypocalcemia</p>

A

<p>tingling</p>

<p>chvostek/trousseau sign</p>

<p>EKG- qt prolongation</p>

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97
Q

<p>Angiodysplasia of the colon</p>

A

<p>2nd MC CO gi bleed (vs. div's)</p>

<p>Usually found in cecum and ascending colon</p>

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98
Q

<p><span>Effective for enteroccous</span></p>

A

<p>Ampicillin/Amoxacillin</p>

<p>Vancomycin</p>

<p>Timentin/Zosyn</p>

<p>(Resistant to all cephalosporins)</p>

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99
Q

<p>Lateral to medial femoral anatomy</p>

A

<p>Femoral nerve</p>

<p>Femoral artery</p>

<p>Femoral vein</p>

<p>Empty space (hernia)</p>

<p>Lacunar ligament</p>

<p>Superficial ring</p>

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100
Q

<p>Gastrin</p>

A

<p>G cells of antrum signal EC cells --> His --> Parietal cell --> HCl</p>

<p>Stimulated by ACh, beta ago, AA</p>

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101
Q

<p>Tx for gallstone ileus</p>

A

<p>Stable and healthy- stone removal and take down fistula</p>

<p>Unstable- stone removal only!</p>

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102
Q

<p>septic shock</p>

A

<p>high CI, low SVR, +/- wedge</p>

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103
Q

<p>Normal SBP in a neonate</p>

A

<p>60-90</p>

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104
Q

<p>How to reach D2 during EGD</p>

A

<p>right rotation and manipulate the up/down control knob</p>

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105
Q

<p>S/e of tamoxifen</p>

A

<p>dvt/pe</p>

<p>uterine cancer</p>

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106
Q

<p>Best test for resectability and staging of eso cancer</p>

A

<p>Resectability- ct</p>

<p>Staging- US</p>

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107
Q

<p>Specific to UC</p>

A

<p>Crypt abscess</p>

<p>Psuedopolyps</p>

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108
Q

<p>LeFort fxs</p>

A

<p>I- palate</p>

<p>II- nose and palate</p>

<p>III- entire face</p>

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109
Q

<p>Epoteitn</p>

A

<p>stimulated by HYPOXIA produced by kidney fibroblasts</p>

<p>Liver is major producer of EPO in fetus</p>

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110
Q

<p>Cutoff for low risk lung nodules not requiring follow-up</p>

A

<p>6mm</p>

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111
Q

<p>Best opioid to use for AKI</p>

A

<ul> <li>methadone and fentanyl/sufentanil</li> <li>hydromorphone or oxycodone are used with caution</li></ul>

<p>morphine and codeine are avoided</p>

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112
Q

<p><span>Anti-staph Penicillins</span></p>

A

<p>Oxacillin</p>

<p>Methicillin</p>

<p>Nafcillin</p>

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113
Q

<p>Bile concentration</p>

A

<p>Sodium chloride channels actively transport salt across the epithelium efficientlyand water follows passively in response to the resultant osmotic force</p>

<p></p>

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114
Q

<p>Warthin tumor/Papillary cystadenoma</p>

A

<p>benign tumor of salivary gland</p>

<p>often BILATERAL and 2/2 smoking</p>

<p>Tx- complete resection with uninvolved margins even if ASx</p>

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115
Q

<p>Hurthle cell</p>

A

<p>Usually benign</p>

<p>MUST do lobectomy to diagnose</p>

<p>tx- total thyroid if malignant. XRT effective.</p>

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116
Q

<p>Neostigmine</p>

A

<p>reversal of non-depol muscle relaxantsAChE inhibitor</p>

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117
Q

<p>Imaging associated with benign adrenal mass</p>

A

<p>< 10HU</p>

<p>Rapid washout</p>

<p>< 4cm</p>

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118
Q

<p>ITP</p>

A

<p>px- petechiae and megakaryotcytes</p>

<p>tx-steroids (IVIG 2nd line)</p>

<ul> <li>do not tx unless PLT < 30k or 20k in low risk</li></ul>

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119
Q

<p>Paired vs. unparied t test</p>

A

<p>Paired- compares study subjects at 2 different times (paired observations of the same subject)</p>

<p>Unparied-compares two different subjects</p>

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120
Q

<p>Respiratory quotient</p>

A

<p>CO2 produced / O2 consumed</p>

<p>>1 → carb is major nutrient</p>

<p>.7 → lipids major nutrient</p>

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121
Q

<p>Absolute c/i to spinal anesthesia</p>

A

<p>Infection at the site</p>

<p>Hypovolemia</p>

<p>Allergy</p>

<p>Increased ICP</p>

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122
Q

<p>Parkland formula</p>

A

<p>4 x weight x TBSA 1st 1/2 in 1st 8h</p>

<p>2nd half next 16</p>

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123
Q

<p>Steps of rapid sequence intubation</p>

A

<p>c-spine stabilize → preO2 → fentanyl → etomidate → succinylcholine</p>

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124
Q

<p>Where to find superior and inferior PD during a whipple</p>

A

<p>Superior:pancreatic head</p>

<p>Inferior: uncinate process</p>

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125
Q

<p>Tx of Barrett's</p>

A

<p>low grade dysplasia: repeat scope/bx in 6m</p>

<p>high grade dysplasia: endoscopic mucosal resection</p>

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126
Q

<p>cyclosporine</p>

A

<p>MOA: calcineurin inhibitor</p>

<p>s/e- 100x less potent then tacro, nephrotoxic, hypertrichosis, gum hyperplasia</p>

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127
Q

<p>Effective for VRE</p>

A

<p>Synercid</p>

<p>Linezolid</p>

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128
Q

<p>Kaposi's sarcoma</p>

A

<p>HSV8</p>

<p>Violet/brown papules</p>

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129
Q

<p>T and N staging eso cancer</p>

A

<ul> <li>t1a- LP and MM</li> <li>t1b- SM</li> <li>t2- MP</li> <li>t3- adventitia</li> <li>t4a- resectable structures</li> <li>t4b- unresectable structures</li></ul>

<p>n1: 1-2 nodes</p>

<p>n2: 3-6 nodes</p>

<p>n3: 7+</p>

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130
Q

<p>CRC T and N</p>

A

<p>t1- SM</p>

<p>t2- MP</p>

<p>t3- xMP/subserosa</p>

<p>t4- invade</p>

<p>n1- 1-3, n2- >=4</p>

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131
Q

<p>Triple therapy</p>

A

<p>PP1 + 2 antibioticsabxs: amoxicillin, metronidazole, tetracycline, clarithromycin</p>

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132
Q

<p>Chole docho in REY bypass pt</p>

A

<p>w/ GB --> lap chole with CBD exploration --> ERCP through remnantstomach</p>

<p>w/out GB --> ERCP with double balloon endoscopt --> ERCP throught remnant stomach</p>

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133
Q

<p>bile salt circulation</p>

A

<ol> <li>conjugate in hepatocytes into gly/taurine</li> <li>secreted into bile</li> <li>80% reabsorbed in ileuim ACTIVELY</li> <li>20% DECONJUGATED by bacteria</li> <li>deconjugated salts absorbed in colon PASSIVELY</li> <li>6. 5% is excreted</li></ol>

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134
Q

<p>Howship-Romburg Sign</p>

A

<p>Pain in medial thigh with internal rotation and extension</p>

<p>Suggests an obtruator hernia</p>

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135
Q

<p>MS vs. ED</p>

A

<p>MS- Fibrillin defect (elastin); AD, tall, aortic root dilation, lens defect, arachnodactyly</p>

<p>ED- t1, t3 , t5 collagen defect; hyper elastic skin, hypermobile joints</p>

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136
Q

<p>Most abundant bacteria in the colon</p>

A

<p>Bacteroides fragiles</p>

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137
Q

<p>Liver lesions on arterial phase:</p>

<ul> <li>HCC</li> <li>Mets</li> <li>Adenoma</li> <li>Hemangioma</li> <li>FNH</li></ul>

A

<ul> <li>HCC- Homogeneous enhancement</li> <li>Mets- Hypoattenuation</li> <li>Adenoma- Heterogeneous enhancement</li> <li>Hemangioma- Periph enhancing</li> <li>FNH- Centrifugal enhancing</li></ul>

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138
Q

<p>Number of lung segments</p>

A

<p>R-10</p>

<p>L-8</p>

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139
Q

<p>confounding</p>

A

<p>a variable that influences both thedependent variable and independent variablecausing a spurious association</p>

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140
Q

<p>Epidural hematoma</p>

A

<p>Biconvex</p>

<p>MMA</p>

<p>DOES NOT suture lines</p>

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141
Q

<p>Bethesda criteria for thyroid</p>

A

<p>10 mm is cutoff to get an FNA</p>

<ol> <li>Non-diagnostic → repeat FNA</li> <li>Benign → follow-up</li> <li>Undetermined significance → repeat FNA</li> <li>Suspicious for follicular neoplasm → lobectomy, repeat FNA, or genetic testing (no core needle)</li> <li>Suspicious for malignancy → lobectomy vs. thyroidectomy</li> <li>Malignant → thyroidectomy</li></ol>

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142
Q

<p><span>Effective for P/A/S</span></p>

A

<p>Ticarcillin (+ticarcillin), Piperacillin (+Zosyn)</p>

<p>3/4G cephalosporin (ceftriaxone, cefepime)</p>

<p>Aminoglycodies (genta, tobra)</p>

<p>Flouroquinolones</p>

<p>Meropenem/Imipenem</p>

<p></p>

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143
Q

<p>HNPCC and criteria</p>

A

<p>HNPCC pts who fulfill Amsterdam clinical criteria for Lynch syndrome</p>

<p>Criteria:</p>

<ul> <li>3 relatives (one 1st deg)w/ Lynch syndrome-associated cancer (CRC, endometrial, small bowel, ureter/renal)</li> <li>2 successive generations</li> <li>1 < 50 yo</li></ul>

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144
Q

<p>MALT lymphoma</p>

A

<p>associated w/ h. Pylori.</p>

<p>Tx:</p>

<ul> <li>Low grade: triple therapy</li> <li>High grade: chemo and XRT (CHOP) +/- rituximab</li></ul>

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145
Q

<p>MCCO chylous ascites</p>

A

<p>malignancy</p>

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146
Q

<p>Gastroschisis</p>

A

<p>GastRoschisis to the Right of midline</p>

<p>rare defects...EXCEPTION- instestinal atResia</p>

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147
Q

<p>Tx of AT3 def</p>

A

<p>Heparin does not work!</p>

<p>Tx- recombinant at3 or FFP followed by heparin then warfarin</p>

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148
Q

<p>Indications to tx ICA stenosis</p>

A

<p>if Asx, only tx if > 60</p>

<p>if sx, tx if > 50</p>

<p>sxs- contralateral motor/sensory sxs, ipsi vision sxs</p>

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149
Q

<p>STSG vs. FTSG</p>

A

<p>STSG- epi + part dermis; worse cosmesis; more contracture! (don't use over joints)</p>

<p>FTSG- epi + dermis; lower survival; more resistant; hypertrophic scar formation; more sensation</p>

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150
Q

<p>ASA</p>

A

<p>irreversible inhibitor of PG metabolism in PLTs</p>

<p>2/2 cox acetylation</p>

<p>7-days of PLT dysfunction</p>

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151
Q

<p>Tx for beta blocker overdose</p>

A

<p>glucagon</p>

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152
Q

<p>Products of anterior pituitary</p>

A

<p>TSH, ACTH, FSH/LH, GH, Pro</p>

<p>neurosecretory cell stimulates hypothalamus which lets go of releasing hormone</p>

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153
Q

<p>Rapid coumadin reversal</p>

A

<p>PCC</p>

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154
Q

<p>Pyoderma gangrenosum</p>

A

<p>associated w/ IBD</p>

<p>RESOLVES after resection</p>

<p>pre-tibial</p>

<p>tx- steroids</p>

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155
Q

<p>Central cord syndrome</p>

A

<p>loss of pain, temp, motor</p>

<p>motor UE> LE loss (vs. anterior syndrome)</p>

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156
Q

<p>Scope schedule after Crohn's dx</p>

A

<p>10 years after dx then every year to r/o dysplasia</p>

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157
Q

<p>TNFa</p>

A

<p>produced by macrophages</p>

<p>causes cachexia</p>

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158
Q

<p>Beckwith Wiedmann Syndrome</p>

A

<p>3m-2yAssociated with hepatoblastoma and wilm's tumor</p>

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159
Q

<p>type 1 choledochocal cyst</p>

A

<p>fusiform dilationtx- excision w/ REY H-J</p>

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160
Q

<p><span>Cryo</span></p>

A

<p><span>vWF, f8, fibrinogen</span></p>

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161
Q

<p>Breslow depth</p>

A

<p>t1: < 1mm → .5-1 cm margin</p>

<p>t2: 1-2 mm → 1-2 cm margin</p>

<p>t3: > 2 mm → 2 cm margin</p>

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162
Q

<p>Best test to dx gastroparesis</p>

A

<p>Scintigraphic gastric emptying</p>

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163
Q

<p>Atlanta classification pancreatits</p>

A

<p>1. Interstitial:</p>

<ul> <li><4w- acute peripanc collection,</li> <li>>4w psuedocys</li></ul>

<p>t2. Necrotic:</p>

<ul> <li><4w- acute necrotic collection</li> <li>>4w- walled of necrosis</li></ul>

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164
Q

<p><span>FFP</span></p>

A

<p><span>All factors, Protein C and S, AT3</span></p>

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165
Q

<p>Child's Pugh Score</p>

A

<p>Billirubin, Albumin, INR, Ascites, Encephalopathy</p>

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166
Q

<p>ARDS ratio</p>

A

<p>P/F</p>

<ul> <li>mild- 200 to 300</li> <li>moderate 100-200</li> <li>severe < 100</li></ul>

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167
Q

<p>Orientation of portal triad</p>

A

<p>Bile duct lateral</p>

<p>Hepatic artery medial</p>

<p>Portal vein posterior</p>

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168
Q

<p>Schiatzki's Ring</p>

A

<p>Associated with hiatal hernia</p>

<p>Tx- only if sxatic. dilation and PPI; do not resect</p>

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169
Q

<p>MOA reglan and erythromcyin</p>

A

<p>reglan: dopamine antagonist</p>

<p>erythromycin: motlin receptor agonist causing SM contraction</p>

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170
Q

<p>indications to bx a neck mass</p>

A

<p>confirm FNA or core needle with excisional biopsy!</p>

<ul> <li>>1.5 cm</li> <li>enlarged node withoutsigns of infection</li> <li>persistence after trial of antibiotics and observation >2-4 wks</li> <li>increasing size of mass</li></ul>

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171
Q

<p>Peri-op anti-PLT agents</p>

A

<p>Clopidogrel (plavix): hold 5-7 days before elective surgery</p>

<p>ASA: continue through the surgery</p>

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172
Q

<p>neurogenic shock</p>

A

<p>high CI, low SVR, low wedge</p>

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173
Q

<p>Indications for iHD</p>

A

<p>GFR 10-15 for sxatic</p>

<p>GFR < 5 for asymptomatic</p>

<p>Sxs = AEIOU (acid, lytes, intox, olverload, uremia)</p>

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174
Q

<p>Breast Cancer in pregnancy</p>

A

<p>1T- MRM. Chemo is not OK.</p>

<p>2T/3T- consider BCT. Modfied radio-isotope. Chemo is OK. Post delivery radiation.</p>

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175
Q

<p>Who needs stress dose steroids</p>

A

<p>>20 mg of steroids for > 3 weeks</p>

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176
Q

<p>Frey syndrome</p>

A

<p>gustatory sweating s/p parotidectomy</p>

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177
Q

<p>Layers of colon/rectum</p>

A

<p>1. mucosa</p>

<p>2. sub-mucosa</p>

<p>3. muscularis propria</p>

<p>4. serosa</p>

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178
Q

<p>FNH</p>

A

<p>path- CENTRAL STELLATE SCAR!; bright on arterial phase homogenous</p>

<p>tx- resect if sxatic. no malignant potential.</p>

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179
Q

<p>TOF</p>

A

<p>Most common cyanotic defect</p>

<p>VSD, PS, OA, RVH</p>

<p>tx- beta blocker; surgery at 3-6m</p>

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180
Q

<p>Omphalocele</p>

A

<p>2/2 failure of umbo ring closure 11th week gut returns to abdominal cavity</p>

<p>normal bowel (protected)</p>

<p>Other congenital defect are more common</p>

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181
Q

<p>Hard signs of vascular injury</p>

A

<p>shock</p>

<p>expanding hematoma</p>

<p>pulsatile bleed</p>

<p>thrill/bruit</p>

<p>absent pulse</p>

<p>ischemia</p>

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182
Q

<p>Primary lymphoid organ vs. secondary</p>

A

<p>Primary: generate cells i.e. liver, bone, thymus</p>

<p>Secondary: maintain cells i.e. nodes, spleen, MALT</p>

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183
Q

<p>Tx of liver lesions:</p>

<p>Hemangioma</p>

<p>FNH</p>

<p>Adenoma</p>

A

<ul> <li>Hemangioma: only if sxatic or KM syndrome</li> <li>FNH: NTD</li> <li>Adenoma: < 4cm w/out OCP response or > 4cm</li></ul>

184
Q

<p>s/e of silver nitrate, silver sulfadiazene, mafenide</p>

A

<p>Silver nitrate- eletrolytes disturbace (no sulfa)</p>

<p>Silver sulfadizene- neutropenia, sulfa</p>

<p>Mafenide- met acidosis, sulfa</p>

185
Q

<p>Tx of complete CBD transection</p>

A

<p>REY HJ has better long term outcome than primary repair</p>

186
Q

<p>Indications for neoadjuvant therapy for stomach cancer</p>

A

<p>Any T2 lesion or LN involvement</p>

<p>T2: growth into the muscularis propria</p>

187
Q

<p>Number of LN needed for gastric vs. CRC</p>

A

<p>gastric- 15CRC- 12</p>

188
Q

<p>Thyroid ima</p>

A

<p>supplies medial aspect of both lobes of the thyroidcome off the innominate/brachiocephalic</p>

189
Q

<p>long chain vs. medium chain TG</p>

A

<p>LC- absorbed by lymphatics</p>

<p>MC- absorbed into blood</p>

190
Q

<p>Fuel for SB and LB</p>

A

<p>SB- glutamine</p>

<p>LB- SCFA</p>

191
Q

<p>Torsades</p>

A

<p>2/2 hypoK, hypoCa, hypoMg</p>

<p>all cause qt prolongation</p>

192
Q

<p>Carcinoid vs. GIST origin and tx</p>

A

<ol> <li>carcinoid- Kulchinsky cells (enterochromaffin-like) <ul> <li>< 2cm --> appendectomy</li> <li>> 2cm --> R hemi</li> <li>chemo if unresectable</li> </ul> </li> <li>GIST- cajal cells <ul> <li>tx- resection</li> <li>imantinib</li> </ul> </li></ol>

<p></p>

193
Q

<p>Thoracic duct course</p>

A

<p>originates at L1-L2 @ c. chyli</p>

<p>cross from R to L at T4-5</p>

<p>empties into L SC/IJ jxn</p>

194
Q

<p>TOF anomalies</p>

A

<ol> <li>Over-riding aorta</li> <li>RV hypertrophy</li> <li>VSD</li> <li>RV obstruction</li></ol>

195
Q

<p>Sevoflurane</p>

A

<p>rapid induction, less laryngospasm, less pungent</p>

<p>good for mask induction</p>

<p>s/e- expensive, liver metabolism</p>

196
Q

<p>Inidications for neoadjuvant chemotherapy for rectal cancer</p>

A

<p>Stage 2 and above</p>

<p>Stage 2: at least t3 (crossing musc prop) or any n (stage 3)</p>

197
Q

<p>Screening guidelines for breast ca</p>

A

<p>annual screening at age 40</p>

198
Q

<p><span>DDAVP</span></p>

A

<p><span>Cause endothelium to release f8 and vWF</span></p>

199
Q

<p>Iron def</p>

A

<p>anemia, glossitis, brittle nails, cardiomegaly</p>

200
Q

<p>Types of vagotomy</p>

A

<p>Highly selective: only removes innervation to lesser curvature</p>

<p>- preserves pylorus → no drainage procedure</p>

<p>Truncal vagotomy: removes lesser curve and pylorus nerves (upstream)</p>

<p>- need pyloroplasty. high r/o dumping syndrome</p>

201
Q

<p>Vitamin K</p>

A

<p>gamma CARBOXYLATION (not decarb) ofGLUTAMATE on 2, 7, 9, 10, c, s</p>

202
Q

<p>Spigelian hernia</p>

A

<p>found along semilunar line lateral to rectus</p>

<p>all should be repaired</p>

203
Q

<p>Ethylene glycol toxicity</p>

A

<p>metabolized in the liveroxalate stones → renal failureanion gap met acid </p>

204
Q

<p>type 4 choledochocal cyst</p>

A

<p>extra/intra dilations</p>

<p>tx- excision w/ REH H-J</p>

205
Q

<p>Hyperacute rejection mechanism</p>

A

<p>Host IgG towards class 1 MHC</p>

206
Q

<p>PPV, NPV</p>

A

<p>PPV = of the people who test positive how many have the disease</p>

<p>NPV = of the people who test negative how many do not have the disease</p>

207
Q

<p>Isoflurane</p>

A

<p>good for neurosurgery; no increase in ICP</p>

208
Q

<p>Indications for neoadjuvant therapy eso cancer</p>

A

<p>t1b and above OR</p>

<p>any nodal involvement</p>

209
Q

<p>MCCO healthcare infection:</p>

<ul> <li>HAP</li> <li>central line infection</li> <li>SSI</li> <li>UTI</li> <li>GI infection</li></ul>

A

<ul> <li>HAP: staph</li> <li>central line infection- candida</li> <li>SSI- staph</li> <li>UTI- e. Coli</li> <li>GI infection- c. diff</li></ul>

210
Q

<p>Peutz-Jeghers</p>

A

<p>AD</p>

<p>Px- intestinal hamartomas, pigmented oral mucosa</p>

<p>Start screening at 25; scope q2 years</p>

211
Q

<p>T and N staging for gastric cancer</p>

A

<p>t1- SM</p>

<p>t2- MP</p>

<p>t3- xMP/subserosa</p>

<p>t4- invade</p>

<p>n1: 1-2, n2: 3-6, n3: >7</p>

212
Q

<p>MC uni-microbial CO nec fasc</p>

A

<p>Clostridium perfringens</p>

<p>gas gangrene</p>

<p>anaerobic</p>

213
Q

<p>Calcitonin</p>

A

<p>Parafollicular C cells Inhibits osteoclast resorption</p>

<p>Increases Ph excretion</p>

214
Q

<p><span>Halothane</span></p>

A

<p>Slow onset/offset.</p>

<p>Least pungent (children)</p>

<p>s/e:- highest cards depression and arrhythmia</p>

<p>- halothane hepatitis</p>

215
Q

<p>types of endoleak and tx</p>

A

<p>1- proximal or distal seal --> emergent!</p>

<p>2- back bleeding</p>

<p>3- graft defect (tear or overlap leak) --> emergent!</p>

<p>4- porosity</p>

216
Q

<p>ASD</p>

A

<p>L to R shunt</p>

<p>Ostium primum (down syndrome)and secundum</p>

<p>Paradoxical emboli</p>

<p>Repair at 1-2y</p>

217
Q

<p>Atropine</p>

A

<p>competitive inhibitor of ACh at muscarinic receptor liver metabolism</p>

218
Q

<p>Zinc def</p>

A

<p>skin rash, impaired wound healing, testicular atrophy</p>

219
Q

<p>Hepatitis seromarkers</p>

A

<p>Vaccinated: surface Ab POSITIVE</p>

<p>Resolved Hb infection: surface Ab POSITIVE and core Ab POSITIVE</p>

<p>Active infection: surface Ag, surface Ab, and core Ab ALL POSITIVE</p>

220
Q

<p>MCCO Cancer</p>

A

<p>Male- prostate, lung, CRC</p>

<ul> <li>lung, prostate, CRC</li></ul>

<p>Women- breast, lung , CRC</p>

<ul> <li>death: lung, breast, CRC</li></ul>

221
Q

<p>Hereditary pancreatitis</p>

A

<p>PRSS1 trypsinogen mut'n</p>

<p>AD</p>

<p>smoking cessation is important</p>

222
Q

<p>type 2 choledochocal cyst</p>

A

<p>cystic diverticula</p>

<p>tx- excision w/ primary closure (NOT a REY)</p>

223
Q

<p>Reversals:</p>

<ul> <li>BB</li> <li>Tylenol</li> <li>Benzos</li> <li>CN/Nitroprusside</li> <li>Vecuronium/Rocuronium</li> <li>Ethylene glycol</li> <li>Methemoglobinemia</li></ul>

A

<ul> <li>BB overdose: fluids/atropine → glucagon</li> <li>Tylenol: NAC</li> <li>Benzos: flumazenil</li> <li>CN/Nitroprusside: sodium thiosulfate, amyl nitrite</li> <li>Vecuronium/Rocuronium: sugammadex</li> <li>Ethylene glycol: femopizole and bicarb OR ethanol; iHD</li> <li>Methemoglobinemia: methylene blue</li></ul>

224
Q

<p>TASC classifcation</p>

A

<p>TASC a and b usually get endovascular repair</p>

<p>A- < 3cm</p>

<p>B- 3-10 cm</p>

225
Q

<p>Superior laryngeal nerve</p>

A

<p>motor to cricothyroidinjury: high pitch</p>

226
Q

<p>Lipopolysaccharide</p>

A

<p>cell wall of GN bacteria endotoxin</p>

<p>activates complements cascade → sepsis</p>

227
Q

<p>Tylenol metabolsim</p>

A

<ol> <li>Glucuronidation(45-55%)</li> <li>Sulfation (sulfate conjugation) (20–30%)</li> <li>N-hydroxylation and dehydration, then glutathione conjugation, (less than 15%) <ul> <li>hepaticcytochrome P450enzyme system</li> <li>NAPQI</li> </ul> </li></ol>

228
Q

<p>F5 Leiden</p>

A

<p>resistance to protein C and S</p>

<p>acts w/ Xa to converts fibrinogen to fibrin</p>

229
Q

<p>Paget Von Schroetter syndrome</p>

A

<p>narrowing of SC/Ax vein 2/2 mech compression</p>

<p>px- acute swelling</p>

<p>Tx- catheter directed thrombolysis (NOT open thrombectomy)</p>

230
Q

<p>Lung fissures</p>

A

<p>Oblique fissure: aka major fissure; separates upper lobe from lower lobe +/- middle</p>

<p>Horizontal fissure: aka minor fissure; only on the R; separates upper lobe from middle lobe</p>

231
Q

<p>Treatment of Merkel Cell</p>

A

<p>excision</p>

<p>highly radiosensitive. radiate if > 2cm</p>

<p>SLNBx</p>

232
Q

<p>Mucoepidermoid carcinoma </p>

A

<p>MC malignant H/N tumor</p>

233
Q

<p>Staging GB cancer</p>

A

<p>1a- LP --> just cc'ectomy</p>

<p>1b- MM --> cc'ectomy, hepatic/ LN/duct resection</p>

<p>t2- perimuscular CT</p>

<p>t3- organs</p>

234
Q

<p>Copper def</p>

A

<p>pancytopenia, myelopathy, pigmentation change</p>

235
Q

<p>CRC staging</p>

A

<p>stage 1- t1 to t2, n0</p>

<p>stage 2- t3 to t4, n0</p>

<p>stage 3- node involvement</p>

<p>stage 4- m1</p>

236
Q

<p>sirolimus</p>

A

<p>MOA: mTOR inhibitor</p>

<p>s/e- lymphocele, wound complications</p>

<p>- lymphcele can cause mesenteric mass and SBO</p>

<p>benefit- less nephrotoxic</p>

237
Q

<p>DES</p>

A

<p>unorganized peristalisis</p>

<p>normal LES pressure</p>

<p>normal relaxation</p>

<p></p>

238
Q

<p>Selenium def</p>

A

<p>cardiomyopathy, hypothyroid</p>

239
Q

<p>Clinical trial phase</p>

A

<p>1- determine safe dosing and route</p>

<p>2- evaluate effectiveness and side effects</p>

<p>3- determine if better than alternatives</p>

<p>4- follow individuals for s/e's</p>

<p></p>

240
Q

<p>Echinoccocus</p>

A

<p>Hydatid cyst</p>

<p>tx w/ mebendazole</p>

241
Q

<p>Heparin</p>

A

<p>accelerates AT3 activity and INDIRECTLY inhibits thrombin</p>

242
Q

<p>hepatic adenoma</p>

A

<p>path- EARLY HETEROGENEOUS enhancement on A phase w/ rapid washout</p>

<p>tx- stop OCP use. resect if > 5cm or sxatic</p>

243
Q

<p>Specific to Crohn's disease</p>

A

<p>Cobblestoning</p>

<p>Granulomas</p>

<p>Transmural Fistulas</p>

244
Q

<p>Free water deficit</p>

A

<p>TBW x [(Na-140)/140]</p>

<p>TBW = weight x .6 (men) or .5 (women)</p>

245
Q

<p>Spinal vs. Epidural</p>

A

<p>Spinal- below l1/l2; SA space; fast; n/m block</p>

<p>Epidural- any level; epidural space; slow; no block</p>

246
Q

<p>Tx SIADH</p>

A

<p>Chronic – Tx: fluid restriction and diuresis</p>

<p>Acute – Tx: conivaptan, tolvaptan</p>

247
Q

<p>Rocuronium</p>

A

<p>non-depol</p>

<p>rapid onset; best for short procedures</p>

<p>eliminated by liver only</p>

248
Q

<p>type 1 vs. type 2 error</p>

A

<p>type 1: false positive</p>

<p>type 2: false negative</p>

<p>power = 1 - type2</p>

249
Q

<p>Periop DM management</p>

A

<p>Oral agents:</p>

<ul> <li>hold ON THE MORNING of surgery.</li> <li>Resume after surgery (EXCEPT for metformin)</li></ul>

<p>Rapid IV agents:</p>

<ul> <li>withhold while NPO and use with a sliding scale</li></ul>

<p>Intermediate/Long acting:</p>

<ul> <li>give normal dose the night before</li> <li>Give ½ dose the morning of surgery</li></ul>

<p>Pump: keep a basal insulin infusion on the day of surgery - use pump to correct levels as needed</p>

250
Q

<p>T staging indications for neoadjuvant</p>

<p>- eso</p>

<p>- stomach</p>

<p>- colon</p>

<p>- rectal</p>

A

<p>- eso: t1b (SM)</p>

<p>- stomach: t2 (MP)</p>

<p>- colon: t4b (adjacent organs)</p>

<p>- rectal: t3 (through MP)</p>

251
Q

<p>Ureter injuries</p>

A

<p>proximal ⅓ → primary ureterourostomy</p>

<p>middle ⅓ → primary or tran uretero urosotomy</p>

<p>lower ⅓ → re-implanation +/- hitch</p>

252
Q

<p>Hot vs. cold nodules</p>

A

<p>Hot- surgery or iodine ablation --> unlikely cancer</p>

<p>Cold- FNA --> may be cancer</p>

253
Q

<p>Post splenectomy ppx</p>

A

<p>"SHiN"</p>

<p>PPV23 + haemophilus influenzae TYPE B + meningococcal polysaccharide</p>

<p>Electively- 2 weeks before</p>

<p>Emergently- PPV23 directly postop, other two given 2 w post op</p>

254
Q

<p>Milan criteria</p>

A

<p>indications for trx w/ HCC</p>

<ol> <li>Single tumor < 5cm</li> <li>No more than 3 tumors each < 3 cm</li></ol>

<p>5-year transplant pt survival is 65-90%</p>

255
Q

<p><span>Isoflurane</span></p>

A

<p>Good for neurosurgery</p>

<p>Pungent (not used for induction)</p>

256
Q

<p>Hyperkalemia EKG</p>

A

<p>peaked T wave</p>

257
Q

<p>Dexmedetomidine</p>

A

<p>Mech- CNS alpha2 ago</p>

<p>Not an induction agent. Good for intubated pts</p>

<p>Anesthesia and analgesia</p>

<p>s/e- bradycardia</p>

258
Q

<p>MC aortic infections</p>

A

<p>aneurysmal- staph</p>

<p>non-aneurysm- salmonella</p>

259
Q

<p>febrile transfusion rxn</p>

A

<p>RECIPIENTS Ab attack DONOR leukocytes</p>

260
Q

<p>Tx of breast CA in preg</p>

A

<p>partial mastectomy + radiation after preg OR full mastectomy</p>

<p>trastuzumab is c/i</p>

261
Q

<p>Octreotide</p>

A

<p>Somatostatin analogue</p>

<p>Inhibits exocrine function of pancreas and CCK release</p>

<p>Tx for chronic pancreatitis</p>

262
Q

<p>Latent error</p>

A

<p>2/2 condition of system being removed</p>

<p>evident after a “perfect storm”</p>

263
Q

<p>Specific to Crohn's</p>

A

<p>Creeping fat</p>

<p>Skip lesions</p>

<p>Transmural</p>

264
Q

<p>Polyps that require surgery instead of endoscopic resection</p>

A

<p>Submucosal invasion > 1mm</p>

<p>Poorly differentiated</p>

<p><1 mm margin</p>

<p>Lymphovascular invasion</p>

<p>Tumor budding</p>

<p>Sessile polyp (if you can't get it all)</p>

265
Q

<p>Blood supply of pancreas</p>

A

<p>Head: superior PD and inferior PD</p>

<p>Body/tail: splenic</p>

266
Q

<p>Mondor disease</p>

A

<p>tender, “cord-like” structure</p>

<p>tx- NSAIDs</p>

267
Q

<p>Criteria for transanal excision of adenocarcinoma</p>

A

<p>T0 or T1 (submucosa)</p>

<p>< 3 cm</p>

<p>< 30% circumference</p>

<p>Palpable on DRE (<8cm from anal verge)</p>

268
Q

<p>Meckel's Diverticulum</p>

A

<p>Anti-mesenteric border of SB</p>

<p>2/2 peristant viteline duct</p>

<p>pancreatic and gastric tissue</p>

<p></p>

269
Q

<p>Acetazolamide</p>

A

<p>Inhbitis carbonic anhydrase</p>

<p>Interferes with bicarb resorbtion causing non-AG metabolic acidosis</p>

270
Q

<p>hypovolemic shock</p>

A

<p>low CI, high SVR, low wedge</p>

271
Q

<p>Tx for hemobilia</p>

A

<p>angioembolization</p>

272
Q

<p>PFTs for lung resection</p>

A

<p>FEV1 >1.5L lobe, >2L pneumo --> OK for surgery</p>

<p>If not: lung scan</p>

<p>PPO FEV1 > .8L (>40%)</p>

<p>PPO DLCO > 10 ml/min/mmHg (>40%)</p>

<p>If not: exercise test</p>

<p>VO2 > 10 ml/min/kg --> OK for surgery</p>

273
Q

<p>Succinylcholine</p>

A

<p>ONLY depolarizing</p>

<p>short half life and rapid onset (RSI)</p>

<p>degraded by plasma CE</p>

<p>s/e: rhabdo, ocular HTN, malig hyperthermia, hyperK</p>

<p>c/i: spinal cord injury, renal failure, large burns</p>

274
Q

<p>dcis vs. lcis</p>

A

<ol> <li>dcis: excisional bx <ul> <li>1mm margin</li> <li>no SLN unless mastectomy</li> </ul> </li> <li>lcis: excisional bx <ol> <li>marginfor LCIS --> no further intervention. consider hormone tx or ppx mastectomy</li> <li>margin positive for DCIS/invasive ca --> surgery</li> </ol> </li></ol>

275
Q

<p>Sarcoma T and N staging</p>

A

<p>T1- <5 cm</p>

<p>T2- > 5cm</p>

<p>N1- regional nodes</p>

276
Q

<p><span>Etomidate</span></p>

A

<p>Fewer hemodynamic changes</p>

<p>Fast acting</p>

<p>Fewest cards s/e</p>

<p>s/e- adrenocortical suppresion w/ cont infusion</p>

277
Q

<p>basiliximab </p>

A

<p>MOA: IL2 inhibitor</p>

278
Q

<p>Midodrine</p>

A

<p>a1 agonist</p>

279
Q

<p>Li Fraumeni</p>

A

<p>p53 mutation</p>

<p>breast ca + soft tissue sarcoma</p>

280
Q

<p>Tx of Ogilvie's</p>

A

<p>supportive, dc narcotics, ng tube, neostigmine</p>

<p>if > 10cm --> scope decompression and neostimgine</p>

<ul> <li>failure --> OR</li></ul>

281
Q

<p>MCCO cauti</p>

A

<p>1. e. coli</p>

<p>2. enterococcus</p>

<p>3. candida</p>

282
Q

<p>cardiogenic</p>

A

<p>low CI, high SVR, high wedge</p>

283
Q

<p>GCS eye opening</p>

A

<p>4- spon</p>

<p>3- to voice</p>

<p>2- to pain</p>

<p>1- none</p>

284
Q

<p>Dysplasia of any grade in the GI tract</p>

A

<p>polypectomy will suffice</p>

<p>need to re-scope in 3m if high grade or sessile</p>

<p>if there is SM invasion --> surgical resection</p>

285
Q

<p>Markers:</p>

<p>Ca 125</p>

<p>bHCG</p>

<p>AFP</p>

<p>Inhibin</p>

A

<p>Ca 125- epithelial</p>

<p>bHCG- choriocarcinoma</p>

<p>AFP- germ cell/endodermal/yolk sac</p>

<p>Inhibin- granulosa/sex-cord</p>

286
Q

<p>Inguinal hernia nerves</p>

A

<p>Ilioinguinal- MC in open repair; runs ant/top of cord; under EO</p>

<p>Iliohypogastric</p>

<p>GB of GF</p>

<p>Lateral femoral cutaneous- MC in lap repair; injured laterally</p>

287
Q

<p>Axis of gastric volvulus</p>

A

<ol> <li>Organoaxial: rotate around the long/vertical axis</li> <li>Mesenteroaxial: rotate around wide/horizontalaxis</li></ol>

288
Q

<p>neostigmine</p>

A

<p>MOA: increased PS activity (AChE-I)</p>

<p>tx for ogilvie's</p>

<p>MONITORED SETTING w/ atropine b/c high r/o BRADYCARDIA</p>

<p>b4 r/o mech obsxn 1st or r/o perf b/c of enhanced motility and pressure</p>

289
Q

<p>Somatostatinoma</p>

A

<p>Loc: head</p>

<p>Px: DM, gallstones, steatorrhea, block exo/endo pancreas</p>

290
Q

<p>Tx of prolactinoma</p>

A

<p>if sxatic or macroadenoma</p>

<ul> <li>bromocriptine or carbegoline (both dopa agonists)</li> <li>bromo is safe in pregnancy</li></ul>

<p>surgery if failure</p>

291
Q

<p>Sub-acute thyroiditis</p>

A

<p>Recent viral URI</p>

<p>tx- NSAIDs/steroids</p>

292
Q

<p>Variceal bleeding 2/2 pancreatits</p>

A

<p>Splenic vein thrombosis</p>

<p>tx- splenectomy</p>

293
Q

<p>VW disease</p>

A

<p>1- low quantity. tx- desmo and cryo</p>

<p>2- low quality: tx- only cryo</p>

<p>3- complete absence: tx- cryo and desmo</p>

<p>dx- ristocetin test or measure vWF level</p>

294
Q

<p>Loss in excess weight for each surgery</p>

A

<p>REYGB- 75%</p>

<p>SG- 60%</p>

<p>Lap band- 50%</p>

295
Q

<p>Gastric ulcers</p>

A

<p>1- lesser curve/antrum; normal acid</p>

<p>2- gastric + duo; high acid</p>

<p>3- pre pyloric: high acid</p>

<p>4- GE junction: normal acid</p>

296
Q

<p>Modified radical mastectomy</p>

A

<p>mastectomy with ALND (level 1 and 2 only) w/ sparing of pectoralis</p>

297
Q

<p>layers of the eso</p>

A

<ol> <li>Mucosa <ul> <li>epithelium</li> <li>LP</li> <li>MM</li> </ul> </li> <li>Sub-mucosa (lots of lyphatics!)</li> <li>MP</li> <li>Adventitia</li></ol>

<p>NO serosa!</p>

298
Q

<p>Duration of treatment - tamoxifen and trastuzumab</p>

A

<p>Tamoxifen- 5y</p>

<p>Trastuzumab- 1y</p>

299
Q

<p>F11 def</p>

A

<p>r/o bleeding w/ surgery</p>

<p>tx- FFP (not f11 concentrate!)</p>

300
Q

<p>Margin for LE sarcoma</p>

A

<p>2cm</p>

301
Q

<p>Somatostatin</p>

A

<p>D cells in stomach, duo and panc</p>

<p>Shuts off insulin, glucagon, and gastrin</p>

<p>Stimulated by acid</p>

302
Q

<p>Stimulation of CCK release</p>

A

<p>fatty acids and amino acidsin thechymeentering theduodenum</p>

<p>CCK-releasing protein</p>

<p>ACh</p>

303
Q

<p>Order of potency of steroids</p>

A

<ol> <li>HC</li> <li>Pred</li> <li>Methylpred</li> <li>Dexameth</li></ol>

304
Q

<p>Cowden's</p>

A

<p>pten mutation</p>

<p>breast ca + thyroid ca + hamartomas</p>

305
Q

<p>long thoracic nerve vs. thoracodorsal nerve</p>

A

<p>LTN → serratus --> winged scap</p>

<p>TD → LD --> difficult shoulder ADduction/Int rotation</p>

306
Q

<p>PLT count trx threhold</p>

A

<p>Stable and non-bleeding -->< 10K</p>

<p>Stable and non-bleeding with temp > 38 --> < 20k</p>

<p>Surgical pt < 50k</p>

<p></p>

<p><20K spontaneous bleeds</p>

307
Q

<p>NNT`</p>

A

<p>NNT = 1/absolute risk reduction (ARR)</p>

<p>ARR = event rate in intervention group - rate in null group</p>

308
Q

<p>half-lifeacoags:</p>

<p>war</p>

<p>hep</p>

<p>noac</p>

A

<p>war - 36h</p>

<p>hep 90m</p>

<p>noac- 12h</p>

<p>3.5 half lives to ss</p>

<p></p>

309
Q

<p>Achalasia</p>

A

<p>no peristalsis</p>

<p>high LES pressure</p>

<p>incomplete relaxation</p>

<p></p>

310
Q

<p>MEN syndromes</p>

A

<p>1- panc, pit, PT</p>

<p>2a- PT,MTC, pheo</p>

<p>2b- pheo, MTC, marfanoid/neuromas</p>

311
Q

<p>Tx of cholangiocarcinoma</p>

A

<p>1. Upper 3rd- duct resection w/ partial hepatectomy</p>

<p>2. Middle 3rd- bile duct resection + LADN</p>

<p>3. Lower 3rd- Whipple</p>

<p>*Locally advanced/unresectable- transplant</p>

312
Q

<p>Types of Shunts</p>

A

<ol> <li>Total: porto-caval, meso-caval</li></ol>

<ul> <li>Relieves bleeding and ascites</li> <li>More hepatic encephalopathy</li></ul>

<ol> <li>Partial: distal spleno-renal</li></ol>

<ul> <li>Relives bleeding only</li></ul>

313
Q

<p>Glucagonoma</p>

A

<p>Loc: distal</p>

<p>Px: dermatitis, DRH, DM, nec mig erythema</p>

314
Q

<p>MELD</p>

A

<ol> <li>Bili</li> <li>INR</li> <li>Creatinine</li></ol>

<p></p>

315
Q

<p>Pancreatic ducts</p>

A

<p>Wirsung- major, lies inferior</p>

<p>Santorini- minor, lies superior</p>

316
Q

<p>Hypokalemia EKG</p>

A

<p>qt prolongation</p>

317
Q

<p>Entamoeba histo</p>

A

<p>MExico</p>

<p>tx with MEtronidazole (no OR!)</p>

<p>NO rim enhancement (vs. amoebic abscess)</p>

<p>dx- EIA (assay)</p>

318
Q

<p>Group A strep</p>

A

<p>strep pyogenes</p>

<p>suspect if gas and bullae</p>

319
Q

<p>Imatinib</p>

A

<p>competitive inhibitor of TK</p>

<p>tx for GIST</p>

320
Q

<p>Tx of ovarian vein thrombosis</p>

A

<p>Anticoagulation</p>

<p>Abx if septic sxs</p>

321
Q

<p>Pyogenic abscess</p>

A

<p>MC- biliary dz and bile obstruction; e. Coli and kleb</p>

<p>tx- perc drainage is 1st line!</p>

322
Q

<p>clostridium</p>

A

<p>anaerobic, GPR</p>

<p>MC CO emphysematous cholecystitis</p>

<p>MC CO gas gangrene</p>

<p>tx- PCN, clinda 2nd line</p>

323
Q

<p>Light's criteria</p>

A

<ol> <li>PLprotein/serum Pr >.5</li> <li>PLLDH/serum LDH > .6</li> <li>PL LDH > 2/3 ULN</li></ol>

324
Q

<p>Tx of psuedocyst</p>

A

<p><6cm and <6w --> conservative</p>

<p>>6cm and >6w --> drain if sxatic (perc cath, endoscopic methods, or surgery)</p>

<p></p>

325
Q

<p>Arterial content </p>

A

<p>(1.34 x Hb x Sa02) + (.003 x PaO2)</p>

326
Q

<p>tx of eso cancer by t stage</p>

A

<p>t1a- mucosal resection</p>

<p>t1b- esophagectomy</p>

<p>t2- esophagectomy</p>

<p>t3- esophagectomy</p>

<p>t4a- esophagectomy</p>

<p>t4b- chemo/rads</p>

<p>cervical- chemo/rads</p>

327
Q

<p>FAP screening and treatment</p>

A

<ul> <li>Scopes annually starting at 10-12y</li> <li>life-long screening for APC carriers.</li> <li>Can stop at 40 if not APC carrier</li></ul>

<p>Indications for colectomy</p>

<ul> <li>Suspected colorectal cancer</li> <li>Severe symptoms</li> <li>High-grade dysplasia</li> <li>Multiple adenomas larger than 6 mm</li> <li>Marked increases in polyp number on consecutive exams</li> <li>Inability to adequately survey the colon because of multiple diminutive polyps</li></ul>

328
Q

<p>Stewart-Treves syndrome</p>

A

<p>post mastectomy lymphangiosarcoma</p>

<p>rare and highly malignant</p>

<p>Tx- wide local excision w/ 3-6 cm margin</p>

329
Q

<p>Fibrinogen</p>

A

<p>binds gp2b/3a receptors to link PLTs together</p>

330
Q

<p>Ranson's criteria at 48 h</p>

A

<p>"C and Hobbs"</p>

<ol> <li>Ca < 8</li> <li>HCT down > 10 pts</li> <li>O2 < 60</li> <li>Base deficit > 4</li> <li>BUN > 5</li> <li>Sequestration of fluids > 6L</li></ol>

331
Q

<p>Hemangioma</p>

A

<p>path- PERIPHERAL ENHANCEMENT</p>

<p>tx- if rupture, size change, or KM syndrome</p>

332
Q

<p>Drainage of gonadal veins</p>

A

<p>R- IVC</p>

<p>L- L renal vein</p>

333
Q

<p>T staging for HCC</p>

A

<p>T1: any size without vascular invasion</p>

<p>T2: < 5 cm with vascular invasion</p>

<p>T3: > 5 cm with vascular invasion</p>

<p>T4: invade adjacent organs</p>

334
Q

<p>Indications of breast MRI</p>

A

<ul> <li>high risk women</li> <li>occult breast cancer</li></ul>

335
Q

<p>T staging for esophageal cancer</p>

A

<p>t1a- muscularis mucosa</p>

<p>t1b- SM</p>

<p>t2- muscularis propria</p>

<p>t3- adventitia</p>

<p>*no serosa</p>

336
Q

<p>Halothane</p>

A

<p>cheapest</p>

<p>effective at low concentration</p>

<p>s/e- ventricular arrhythmia, hepatic necrosis</p>

337
Q

<p>Stress induced gastritis</p>

A

<p>Stress elevated ACh</p>

<p>ACh --> parietal cells --> ATPase H+ secretion</p>

338
Q

<p>Grading of splenic injury</p>

A

<p>1- <1 cm,</p>

<p>2- 1-5 cm,</p>

<p>3- > 5cm,</p>

<p>4- segment/hilar vessels,</p>

<p>5- shattered</p>

<p>Return to activity → injury grade + 2; so grade 2 would be 4 weeks</p>

339
Q

<p>Tx of Zenkers</p>

A

<p><2cm: circopharyngeal myotomy</p>

<p>2-5 cm: myotomy +/- diverticulectomy</p>

<p>>5cm: myotomy + diverticulectomy</p>

340
Q

<p>Liver collection tx</p>

<p>Pyo-</p>

<p>Amoebic-</p>

<p>Echino-</p>

A

<p>Pyogenic- drain and abx</p>

<p>Amoebic- metronidazole</p>

<p>Echinococcal- albendazole and resect</p>

341
Q

<p>AT3 def</p>

A

<p>AD</p>

<p>non-vit K dependent protease for 10a potentiated by heparin</p>

<p>tx- FFP</p>

342
Q

<p>Fibrolamellar HCC</p>

A

<p>well circumscribed w/ central scar similar to FNH</p>

<p>normal AFP and elevated neurotensin (Vs. FNH)</p>

343
Q

<p>Warfarin</p>

A

<p>competitive inhibitor of epoxide reductase (vit K activator)</p>

344
Q

<p>Human bite tx</p>

A

<p>amox/clavulanate (augmentin)</p>

<p>MC for human bites- eikenella</p>

345
Q

<p>Variceal bleeding after distal pancreatectomy</p>

A

<p>Gastric varices</p>

<p></p>

346
Q

<p>NNT</p>

A

<p>1/ARR</p>

<p>ARR = risk w/ tx - risk w/ placebo</p>

347
Q

<p>Surveilance schedule for FAP, HNPCC</p>

A

<p>FAP- start at 10</p>

<p>HNPCC- start at 20</p>

348
Q

<p>preA vs. Albumin</p>

A

<p>Prealbumin: t1/2 is 1-2 days; best marker for short-term nutritional status</p>

<p>Albumin: t1/2 is 21 days; biomarker of long term nutrition; pre op assessment</p>

349
Q

<p>Cause of:</p>

<p>graves</p>

<p>TMN</p>

<p>Hashimoto's</p>

<p>DeQuervains</p>

A

<p>graves- IgG against TSHr</p>

<p>TMN- hyperplasia 2/2 low grade TSH stimulation</p>

<p>Hashimoto's- antiTG abs (cell-med and humoral)</p>

<p>DeQuervains- viral URI</p>

350
Q

<p>Mechanical valve periop</p>

A

<p>restart coumadin in 12-24h and bridge w/ heparin or lovenox</p>

351
Q

<p>Vitamin D processing</p>

A

<p>7-DHC + sunlight --> d3</p>

<p>liver --> 25-d3</p>

<p>kindey --> 1,25-d3</p>

352
Q

<p>Requirements for lung surgery</p>

A

<p>- FEV1 > 1.5L (lobectomy), > 2L pneumonectomy</p>

<p>- pppo FEV1 > 40%</p>

<p>- ppo DLCO > 40%</p>

<p>- VO2max > 15</p>

353
Q

<p>TRAM flap</p>

A

<p>SUPERIOR epigastric arterycan use ipsi or contra muscle</p>

354
Q

<p>Normal values: CVP, WP, SVR, CI</p>

A

<p>CVP 2-6</p>

<p>WP 4-12</p>

<p>SVR 700-1500</p>

<p>CI 2.5-4</p>

355
Q

<p>Loop diuretics vs. Ca sparing diuretics</p>

A

<p>loop- furosemide</p>

<p>Ca sparing- thiazides</p>

356
Q

<p>Indications for chemo with breast cancer</p>

A

<p>> 1cm</p>

<p>Cx positive nodes</p>

<p>Triple negative</p>

<p>Poor oncotype</p>

357
Q

<p>TLV</p>

A

<p>TLV = RV + ERV + TV + IRV</p>

<p>FRC = RV + ERV</p>

<p>IC = TV + IRV</p>

358
Q

<p>VIPoma</p>

A

<p>Loc: distal</p>

<p>Px: watery DRH, hypoK, achlorhydria, inhibits gastrin</p>

359
Q

<p>Types of rejection</p>

A

<p>hyperacute- preformed IgG against donor; t2HS</p>

<p>acute- T and B cell resposne to MHC; t4HS</p>

<p>graft vs. host- graft T-cells attach host; t4HS</p>

<p></p>

360
Q

<p>Neoinitmal hyperplasia</p>

A

<ul> <li>proliferation and migration of vascularsmooth muscle cellsprimarily in thetunica intima, resulting in the thickening ofarterial wallsand decreased arteriallumenspace.</li> <li>cause of restonisis after CEA</li></ul>

361
Q

<p>Benign lesions that require excisional bx</p>

A

<ul> <li>Atypical DH/LH</li> <li>LCIS/DCIS</li> <li>radial scar</li> <li>papillary lesion</li> <li>any atypia</li></ul>

362
Q

<p>MC nerve injury Br/Bac fistula</p>

A

<p>medial brachial cutaneous n.</p>

363
Q

<p>Pyloric stenosis</p>

A

<p>px-hypochloremic,hypokalemic metabolic alkalosis</p>

<p>dx- US</p>

<p>tx- pyloromyotomy</p>

364
Q

<p>Treatment of SVT</p>

A

<p>Vagal maneuvers or adenosine</p>

365
Q

<p>Fuel for colonocytes</p>

A

<p>SCFA (acetate, butyrate, propionate)</p>

366
Q

<p>Tx for hyponatermia</p>

A

<p>Acute sxatic: hypertonic saline</p>

<p>Hypervolemia: hypertonic saline</p>

<p>Euvolemic and asxatic: free water restriction</p>

<p>Hypovolemic: volume resuscitate w/ LR or NS</p>

367
Q

<p>Zone injuries</p>

A

<p>penetrating:</p>

<ul> <li>zone 1-3 --> explore</li></ul>

<p>blunt:</p>

<ul> <li>zone1 --> explore</li> <li>zone 2-3 --> do not explore</li></ul>

368
Q

<p>Wiskott-Aldrich Syndrome</p>

A

<p>X-linked</p>

<p>TCPenia + combined b/t cell def + eczema</p>

369
Q

<p>hot vs cold nodules</p>

A

<p>hot- surgery or iodine ablation</p>

<p>cold- FNA</p>

370
Q

<p>TTP</p>

A

<p>path- def in ADAMtS13</p>

<p>px- TCP purpura, neuro sx, kidney dz, hemo anemia, fever</p>

<p>tx- plasmapheresis → splenectomy if failed</p>

371
Q

<p>Layers of mucosa</p>

A

<p>Epithelium</p>

<p>Lamino Propria</p>

<p>Muscularis mucosa</p>

372
Q

<p>What is not suppressed by high dose dexa</p>

A

<p>Adrenal mass</p>

<p>Ectopic mass (small cell cancer)</p>

373
Q

<p>MOA of tacro, cyclosporine, sirolimus, mmf, basiliximab</p>

A

<p>tacro- calcineurin inhibitor</p>

<p>cyclosporine- calcineurin inhibitor</p>

<p>sirolimus- mTor inhibitor</p>

<p>mmf- cell cycle inhibitor</p>

<p>basilixamab- il2 inhibitor</p>

374
Q

<p>Enzymes secreted in their active form from pancreas</p>

A

<p>Amylase/Lipase</p>

<p>Ribonuclease/Deoxyribonuclease</p>

375
Q

<p>Gastrinoma</p>

A

<p>Loc: gastrinoma triangle (CBD, panic neck, 3D)</p>

<p>Px: refractory PUD, gastrin > 200 on sec stim test</p>

376
Q

<p>dx of colovag and colovesic fistula</p>

A

<p>colovag: tampon test</p>

<p>colovesic: CT scan</p>

377
Q

<p>SCIP guidelines</p>

A

<ul> <li>Ppx abx 1 hour before incision (vanc can be 2hr)</li> <li>DC abx 24h after end time</li> <li>48h for cardiac surgery</li> <li>Cardiac pt should have glucose should be < 200 on POD1 and 2</li> <li>Shaving is inappropriate; should clip hair</li> <li>Remove foley on POD1 or 2</li> <li>Maintain normothermia (=> than 36)</li> <li>Recieve BB 1 day prior to surgery through POD2</li> <li>VTE prophy within 24h of end time</li></ul>

378
Q

<p>Milrinone</p>

A

<p>PD inhibitor</p>

<p>contractility with vasodilation</p>

<p>great for pulmonary hypertension</p>

379
Q

<p>HNPCC inheritance - Amsterdam criteria</p>

A

<p>AD</p>

<p>Defect in MLH/MSH</p>

<ol> <li>3xrelatives</li> <li>2x generations</li> <li>1x < 50y</li></ol>

380
Q

<p>Richter's hernia</p>

A

<p>protrusion and/or strangulation of part of the intestine's anti-mesenteric border</p>

381
Q

<p>Plasmin</p>

A

<p>degrades fibrin and fibrinogen</p>

<p>activated by urokinase and streptokinase</p>

382
Q

<p>HNPCC screening and treatment</p>

A

<ul> <li>scope q1-2y starting at 20-25</li> <li>Surgery if:CRC or endoscopically unresectable</li> <li>TAC with IRA and surveillance rectum</li> <li>prophylactic hysterectomy and BSO offered at the time of colectomy</li> <li>Other screens: <ul> <li>Annualpelvic exam, endometrial bx, TVUS</li> <li>Upper endoscopy with bxofantrum. treatment ofH. pyloriinfection</li> <li>Annual urinalysis</li> <li>Annual skin/neuro exams</li> </ul> </li></ul>

<p></p>

383
Q

<p>Melanoma types</p>

A

<p>superficial spreading- MC</p>

<p>lentigo- sun exposed, best prog</p>

<p>nodular- worst prog</p>

384
Q

<p>Replaced Rand L hepatic</p>

A

<p>R- SMA</p>

<p>L- left gastric</p>

385
Q

<p>RQ of fat, carb, and protein</p>

A

<p>Carb = 1</p>

<p>Protein = .8</p>

<p>Fat = .7</p>

386
Q

<p>RR vs. OR</p>

A

<p>RR: of those who were exposed how many got the dz/of those who were not exposed how many got the dz</p>

<p>- considers total population. good for prospective</p>

<p>OR: odds of exposure in cases / odds of exposure in controls</p>

<p>(a/c)/ (b/d)</p>

<p>- good for retrospective</p>

387
Q

<p>Encapsulate organisms</p>

A

<p>Strep pneumo (MC)</p>

<p>Neisseria</p>

<p>Haemophilus</p>

388
Q

<p>MMF</p>

A

<p>MOA: cell cycle inhibitor</p>

389
Q

<p>Immunonutrients</p>

A

<p>Glutamine</p>

<p>Arginine</p>

<p>Omega-3 FA</p>

390
Q

<p>Gail model</p>

A

<p>age</p>

<p>age 1st period</p>

<p>age 1st birth</p>

<p>1d relative</p>

<p>previous bx</p>

<p>race</p>

391
Q

<p>When to operate on adrenal mass</p>

A

<p>all functioning tumors</p>

<p>all > 6 cm --> open resection (no lap)</p>

<p>if < 6cm with suspicious features (>10HU, slow w/out) --> open resection (no lap)</p>

<p>if bilateral --> tx medically w/spironolactone</p>

392
Q

<p>Origins of medullary thyroid cancer</p>

A

<p>4th pharyngeal arch releases NCC which form parafollicular C cells</p>

393
Q

<p>Bile Acids</p>

A

<p>750 cc/day secreted</p>

<p>Primarybileacids- cholic, chenodeoxycholic</p>

<p>Secondarybileacids- deoxycholic, lithocholic</p>

<p>primarybileacids produced by the liver thenundergo deconjugation in the gut by bacteria.<br></br></p>

394
Q

<p>Component separation</p>

A

<p>External oblique fascia</p>

395
Q

<p>VHL</p>

A

<p>up regulation of vegf</p>

<p>hyper vascular tumors</p>

396
Q

<p>Felty syndrome</p>

A

<p>rheumatoid arthritis,splenomegaly, granulocytopenia</p>

397
Q

<p>Merkel cell ca</p>

A

<p>rare neuroendocrine tumor of the skin</p>

<p>looks like BCC w/out rolled edges</p>

<p>highly radiosensitive</p>

<p>Tx- surgical excision + SLNBx + XRT</p>

398
Q

<p><span>Aminocaproic acid</span></p>

A

<p><span>Plasmin inhibitor</span></p>

<p><span>Use: DIC, excess tpa</span></p>

399
Q

<p>Secretin vs. CCK</p>

A

<p>Both released by duo</p>

<p>S cells --> Secretin- duct cells --> bicarb</p>

<p>I cells --> CCK- acinar cells --> enzymes</p>

400
Q

<p>Nutcracker eso</p>

A

<p>high amplitude/long peristalsis</p>

<p>normal LES pressure</p>

<p>normal relaxation</p>

<p></p>

401
Q

<p>Ectopic parathyroids</p>

A

<p>superior parathyroids is the tracheoesophageal groove and retroesophageal region.</p>

<p>inferior parathyroids- anterior mediastinum, thymus, thyroid gland</p>

<p></p>

402
Q

<p>421 rule for mIVF</p>

A

<p>4 ml/kg/hr for 1st 10 kg</p>

<p>+2 for next 10-20</p>

<p>+1 for every kg above 20</p>

403
Q

<p>Inidications for non-op managemement of eso perf</p>

A

<ul> <li>early diagnosis or delayed diagnosis with contained leak</li> <li>not in the abdomen</li> <li>contained perforation in the mediastinum</li> <li>content of the perf drain back to the esophagus</li> <li>perforation does not involve neoplasm or obstruction of the esophagus</li> <li>absence of sepsis</li></ul>

<p></p>

404
Q

<p>Treatment of GB polyp</p>

A

<p>Sxatic --> resect</p>

<p>High risk or > 6mm --> resect</p>

<p>Low risk --> EUS</p>

<p>> 18 mm --> open cholecystectomy, partial liver resection, and possible lymph node dissection</p>

<p>Gallbladder polyps that are not resected should be followed-up with serial ultrasound examinations</p>

405
Q

<p>Se, Sp</p>

A

<p>Sensitivity = of the people who have the disease how many test positive</p>

<p>Specific = of the people who don’t have the disease how many test negative</p>

406
Q

<p>z11 trial implications</p>

A

<p>If less than 3 nodes positive on SLN and T1 or T2 disease, BCT is OK</p>

407
Q

<p>Splenic vein thrombosis</p>

A

<p>If variceal bleeding tx with splenectomy</p>

408
Q

<p>Cervical neoplasia</p>

A

<p>CIN1- tx infection, close f/up</p>

<p>CIN2- cryo or leep</p>

<p>CIN3- cryo or leep</p>

409
Q

<p>McVay repair</p>

A

<p>Hernia repair without mesh</p>

<p>Approximates TAA to cooper's ligament</p>

410
Q

<p>GCS motor</p>

A

<p>6- obeys commands</p>

<p>5- localized</p>

<p>4- w/draws</p>

<p>3- flexion (decort)</p>

<p>2- extension (decerebrate)</p>

<p>1- none</p>

411
Q

<p>Minimum negative margin for BCC</p>

A

<p>4 mm for unaggressive</p>

<p>8 mm for aggressive tumors</p>

412
Q

<p>CO2 vs. NO2 for pneumoperitoneum</p>

A

<p>CO2 advantage</p>

<p>- doesn't combust. less expensive.</p>

<p>CO2 disadvantage</p>

<p>- acidosis, long elimination, sympathomimetic</p>

413
Q

<p>Mattox maneuver</p>

A

<p>"L --> Mattox"</p>

<p>move left structures to the right</p>

<p>exposure left sided vasculatre</p>

<p>explore aorta and L renal vein</p>

414
Q

<p><span>Propofol</span></p>

A

<p>Rapid distribution and on/off</p>

<p>s/e- hypotension, resp depression, meta acid</p>

<p>metabolism- liver</p>

415
Q

<p>Pancreas drainage procedures</p>

A

<p>Peustow- pancreaticojej (for large duct)</p>

<p>Frey- pancreasticojej + core out head</p>

<p>Berger- pancreatic head resection (for large head)</p>

416
Q

<p>Recurrent laryngeal nerve</p>

A

<p>motor to larynx excluding circothryoidinjury: hoarsness, airway compromise</p>

417
Q

<p>Cryo used to treat?</p>

A

<p>1. VWD</p>

<p>2. Fibrinogen def</p>

<p>3. Hemophilia A</p>

418
Q

<p>Tx for DVT</p>

A

<p>unprovoked: no RF --> 3-6m acoag</p>

<p>provoked: RF --> 3m</p>

<p>open thrombectomy --> last resort forthreatened limb loss secondary to extensive DVT and phlegmasia</p>

419
Q

<p>Contents of FFP and Cryo</p>

A

<p>FFP: all clotting factors; f5 and 8 decrease over time</p>

<p>Cryo: VWF, f8, fibrinogen</p>

420
Q

<p>Ureter anatomy</p>

A

<p>Runs under the vas/uterine arteries</p>

<p>Runs over the iliacs</p>

421
Q

<p>Trauma to the pancreas</p>

A

<p>head</p>

<p>- main duct: drain w/ staged resection</p>

<p>- tail: drain</p>

<p>tail</p>

<p>- main duct: drain</p>

<p>- tail: resect w/ splenectomy (unless child)</p>

422
Q

<p>Central venous O2 vs. mixed venous O2</p>

A

<p>Mixed venous: from PA</p>

<p>Central venous: from SVC only (estimation of mixed)</p>

423
Q

<p>Exposing the pancreas</p>

A

<ol> <li>Head: kocherize</li> <li>Body: incise gastrocolic ligament --> lesser sac</li> <li>Tail: mobilize spleen</li></ol>

424
Q

<p>Cuff size for kids</p>

A

<p>age/4 + 4</p>

425
Q

<p>Crystalloid and colloid for trauma kids</p>

A

<p>Crystalloid: 20cc/kg</p>

<p>PRBC: 10cc/kg</p>

426
Q

<p>qSOFA score</p>

A

<p>AMS (<15)</p>

<p>RR > 22</p>

<p>SBP < 100</p>

427
Q

<p>Nitrogen balance</p>

A

<p>Nitrogen Balance =</p>

<p>Protein intake (grams)/6.25 - (UUN + 4 grams)</p>

<p>UUN =grams of nitrogen excreted in the urine over a 24 hour period</p>

<p>4 = stool and insensible losses</p>

428
Q

<p>s/e of carb, protein, and lipid</p>

A

<p>carb- immunosuppression, resp failure</p>

<p>lipid- pro inflammatory</p>

<p>protein- false neurotransmitters, rise in ammonia/urea</p>

429
Q

<p>Serum osm calculation</p>

A

<p>2xNa + Glu/18 + BUN/2.8</p>

<p></p>

430
Q

<p>Corrected Ca</p>

A

<p>For every 1 drop in albumin below 4, serum Ca drops by .8</p>

431
Q

<p>Acid/Base of Ng suctioning</p>

A

<p>HypoCl, HypoK metabolic alk</p>

<p>Loose HCl and fluid</p>

<p>Turn on RAA system</p>

<p>Retain Na/Excrete acid (paradoxic acidurea)</p>

432
Q

<p>Acetazolamide</p>

A

<p>MOA: Ca inhibitor</p>

<p>Causes kidneys to excrete bicarb causing a metabolic acidosis</p>

433
Q

<p>Ileal conduit</p>

A

<p>Hyperchloremic metabolic acidosis</p>

<p>(urine high in Cl is exchanged for bicarb which is excreted)</p>

434
Q

<p>MC ST sarcoma and dx and tx</p>

A

<p>MC- malignant fibrous histiosarcoma then liposarcoma</p>

<p>dx- core needle then --></p>

<ul> <li><4cm: excisional</li> <li>>4cm: long. incisional</li></ul>

<p>tx- resection. post op xrt if > 5cm. pre op if > 10cm. doxorubicin.</p>

435
Q

<p>Penecillins evolution</p>

A

<ol> <li>Penicillin: strep</li> <li>Methicillin, Oxacillin, Nafcillin: staph</li> <li>Ampicillin, Amoxacillin: enteroccocus</li> <li>Unasyn/Augmentin: GNRs (not psuedo)</li> <li>Ticarcilin/Piperazillin: pseudomonas</li></ol>

436
Q

<p>peri-op anti-PLT therapy in pt with stent/PCI</p>

A

<ol> <li>No CVdz: stop ASA 7-10 days before surgery. Restart after 24-72h depending on bleeding in surgery</li> <li>Known CV dz <ol> <li>Elective surgery: delay surgery until after optimal time</li> <li>Emergent surgert: c/w DAPT unless high bleeding risk</li> </ol> </li></ol>

<p>Dual antiplatelet therapy duration:post-pone elective operations</p>

<ul> <li>two weeks after simple dilatation</li> <li>six weeks after bare-metal stents</li> <li>12 months after drug-eluting stent</li></ul>

<p></p>

437
Q

<p>Acute cholangitis</p>

A

<p>Dx: U/S showing dilation > 7mm w/ jaundice, fever, RUQ pain</p>

<p>Tx:</p>

<ol> <li>Mild and responding to abx: ERCP w/in 72h</li> <li>Severe and non responding: ERCP w/in 24h</li></ol>

438
Q

<p>Relative c/i to componenet separation</p>

A

<ul> <li>Extensive destruction of the components of the abdominal wall</li> <li>Compromise of the superior epigastric arteryand/ordeep inferior epigastric artery,</li> <li>Contaminated operative field</li> <li>Smoking, COPD, DM, ascites</li></ul>

439
Q

<p>Stimulates pancreas from the jejunum</p>

A

<p>CCK</p>

<p>Secretein</p>

<p>GIP</p>

440
Q

<p>MYH gene</p>

A

<p>MYH associated polyposis</p>

<p>AR!</p>

441
Q

<p>Cryoptococcus vs. Coccidiomycosis</p>

A

<p>Crypto- CNS sxs in AIDs pt; tx- amphotericin</p>

<p>Coccidio- pulm sxs in the southwest; tx-amphotericin</p>

442
Q

<p>hypokalemia on EKG</p>

A

<p>ST depression.</p>

<p>T wave inversion</p>

<p>Prominent U waves</p>

<p>Long QU interval</p>

443
Q

<p>Rectal cancer work-up</p>

A

<ul> <li>complete scope: look for synch lesion</li> <li>CT CAP: mets</li> <li>T staging: rectal US (early stage), MRI (late stage)</li></ul>

444
Q

<p>REY GB with choledocho</p>

A

<p>Trans-gastric ERCP</p>

<p>or double balloon endoscopy</p>

445
Q

<p>dx of ischemic colitis</p>

A

<p>endoscopy (although CT should be your first test)</p>

446
Q

<p>SIADH tx</p>

A

<p>acute- vaptans</p>

<p>chronic- h2o restriction, diuresis</p>

447
Q

<p>Breast abscess that fails to resolve after 2 weeks</p>

A

<p>Excisional bx to rule out inflammatory cancer</p>

448
Q

<p>Sarcoma prognosis by grade</p>

449
Q

<p>Tx for ectopic pregnancy</p>

A

<p>Stable– methotrexate or salpingotomy</p>

<p>Unstable– salpingectomy</p>

450
Q

<p>Tx ARDS</p>

A

<p>TV at 4-6 ml/kg</p>

<p>Permissive hypercapnia</p>

<p>P/E < 200 --> high PEEP</p>

<p>P/E < 300 --> prone, nm blockade,</p>

451
Q

<p>Pitfalls of hiatal hernia repair</p>

A

<ul> <li>Left gastric artery along right crus</li> <li>Abberant left hepatic artery in the gastrohepatic ligament</li> <li>vagus nerve</li></ul>

452
Q

<p>MEN genes</p>

A

<p>1- MENIN</p>

<p>2- RET</p>

453
Q

<p>Dx of:</p>

<p>Insulinoma:</p>

<p>Gastrinoma:</p>

<p>Glucagonoma:</p>

<p>VIPoma:</p>

<p>Somatostatinoma:</p>

A

<p>Dx of:</p>

<p>Insulinoma:insulin to glucose ratio > 0.4 after fasting;↑C peptide and proinsulin</p>

<p>Gastrinoma: serum gastrin > 1000 or SS test</p>

<p>Glucagonoma: gasting glucagon level</p>

<p>VIPoma: high VIP and dx of exclusion</p>

<p>Somatostatinoma: fastin somatostatin level</p>

454
Q

<p>Incidentally found Meckel's</p>

A

<ol> <li>Child and young adult- resection of the normal-appearing Meckel's diverticulum</li> <li>healthy, young adults (<50 years of age)-resection of the normal-appearing Meckel's diverticulum if there is a palpable abnormality orlonger than 2 cm</li> <li>>50 years of age, and patients with significant comorbidities- notresecting</li></ol>

455
Q

<p>Chemo drh</p>

A

<p>loperamide --> octreotide</p>

<p>consider c. diff testing if copious or resistant</p>

456
Q

<p>Choledochol cyst epidemiology</p>

A

<p>females and asians</p>

<p>15% get cholagioncarcinoma</p>

457
Q

<p>Tx of desmoid tumors</p>

A

<p>Women, benign but locally invasive;↑recurrences</p>

<p>Gardner’s syndrome</p>

<p>Painless mass</p>

<p>Tx: wide local excision if possible; if involving significant small bowel mesentery, excision may not be indicated→often not completely resectable</p>

<p>Medical Tx:sulindacandtamoxifen</p>

zAbsite Final 2019 (5 decks)

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