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Past papers (rowad book) Flashcards

1
Q

anti inflammatory cytokines

A

IL-10, IL-4, TGF-beta, IL-13

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2
Q

high levels of carbamino compounds is associated with a … shift in the o2-hb dissociation curve

A

right

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3
Q

hypovolemic initial physiological response is

A

increase in catecholamines

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4
Q

why does blood transfusion cause left shift in o2-hb curve

A

decrease 2-3 DPG

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5
Q

why does sickle cell anemia causes a left shift in o2-hb curve

A

HbF

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6
Q

IL-1 is primarily produced by

A

macrophages

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7
Q

factors that can affect the accuracy of pulse oximetry

A

1.nail polish
2. methemoglobinemia
3. dark skin
4.carboxyhemoglobin
5.Ambient light (eg surgical lights)
6. very low O2 sat levels

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8
Q

only type of shock that has an increased Cardiac output

A

Distributive

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9
Q

ETCO2 in PE is

A

decreased

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10
Q

antidote for beta blocker overdose

A

glucagon (through increasing cAMP independent of beta adrenergic receptors)

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11
Q

pulse pressure is only increased in what type of shock

A

distributive

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12
Q

MCC of neurogenic shock

A

spinal cord injuries

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13
Q

Sepsis criteria

A

SIRS+ source of infection

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14
Q

severe Sepsis criteria

A

Sepsis+
Lactic acidosis, SBP <90 or SBP drop ≥40 mm Hg of norma

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15
Q

Septic shock

A

Severe sepsis + hypotension not responding to fluid

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16
Q

The most common sources of infection in septic shock

A

pneumonia
UTI

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17
Q

above what level does spinal cord injury lead to neurogenic shock

A

Above T6

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18
Q

electrolyte abnormalities following massive blood transfusion

A

Hypocalcemia (MC)
Hyperkalemia
Hypomagnesemia

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19
Q

Most common blood product associated with TRALI

A

FFP

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20
Q

Most common blood product associated with allergic reaction

A

FFP
(reaction to donor antigens in plasma)

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21
Q

Cryoprecipitate stored at what temperature

A

below -18C

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22
Q

platelets stored at what temperature

A

22-24C

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23
Q

PRBCs stored at what temperature

A

2-10C

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24
Q

FFP stored at what temperature

A

below -30C

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25
Q

In anesthetized patients, transfusion reactions may present as

A

Diffuse bleeding

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26
Q

Most efficient and common method to decrease incidence of Febrile nonhemolytic transfusion reaction

A

filtration of blood products

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27
Q

blood product with the highest transfusion-transmitted infectious risk

A

platelets

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28
Q

what acid-base disorder occurs following massive blood transfusion

A

Metabolic alkalosis due to conversion of citrate to HCO3

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29
Q

Prothrombin complex concentrate contains

A

factor 1972

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30
Q

lectin complement pathway is activated by

A

This pathway is initiated by the binding of mannose-binding lectin (MBL), collectin 11, and ficolins to microbial surface oligosaccharides and acetylated residues, respectively.

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31
Q

keloid on histopathology

A

chronic inflammation, marked angiogenesis and a large amount of collagen

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32
Q

ischial pressure ulcers is common in

A

paraplegic patients using wheelchair

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33
Q

Most common areas for keloid formation

A

ear lobe, deltoid, parasternal and upper back

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34
Q

firm discrete nodule at the site of previous surgery

A

granuloma

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35
Q

alginate dressing main function in wounds

A

absorb exudate and form gel like barrier

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36
Q

most powerful chemotactic factor for fibroblasts

A

PDGF

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37
Q

the greater the angle of z-plasty the greater the … of scar

A

Length

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38
Q

everted edge ulcer is seen in

A

squamous cell CA

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39
Q

punched out edge ulcer is seen in

A

syphilis, Diabetic ulcer

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40
Q

undermined ulcer edge is seen in

A

Tb, bed sore

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41
Q

bone reaches maximal tensile strength after

A

6 months

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42
Q

the two most important cells in wound healing

A

macrophages and fibroblasts

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43
Q

the MC pathogen associated with cat bites

A

pasteurella multocida

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44
Q

MC organism associated with central line infections

A

coagulase negative staph (staph epidermis)

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45
Q

exotoxin are

A

peptides

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46
Q

exotoxin are produced mainly by

A

gram positive

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47
Q

antibiotic of choice for actinomyces

A

Penicillin G

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48
Q

MC organism cellulitis

A

beta hemolytic streptococcus

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49
Q

c. tetani is

A

gram positive spore forming rod

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50
Q

polyGlactin

A

Vicryl

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51
Q

polyDioxanone

A

PDS

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52
Q

polyGlycaprone

A

Monocryl

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53
Q

the easiest suture to knot

A

silk

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54
Q

the highest tissue reaction of all absorbable sutures

A

Catgut

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55
Q

current type used in bipolar and monopolar devices

A

AC (alternating current)

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56
Q

The most common vessel to be injured during laparoscopic procedure

A

Right common iliac artery

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57
Q

Tumor marker for GIST

A

CD117 (c-KIT)

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58
Q

cell cycle phases

A

G1 (normal cell activity)
S (DNA synthesis)
G2 (prepare mitosis)
M (Mitosis)

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59
Q

Atypia is reversible or not

A

it is reversible if underlying cause is addressed

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60
Q

alcohol based preparations are not effective againt

A

c.diff

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61
Q

preoperative assessment should be done … weeks before surgery

A

2-4 weeks

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62
Q

recommended time of holding for ACR ARB and diuretics before surgery

A

stop day before surgery

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63
Q

recommended time of holding OCPs before surgery

A

stop 4 weeks before surgery

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64
Q

halothane hepatitis clinical picture

A

fever, eosinophilia, jaundice and elevated LFT

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65
Q

which inhalational agent can cause seizure

A

enflurane

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66
Q

propofol is contraindicated in

A

patients with egg allergy
pregnancy
parkinson

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67
Q

Etomidate is mostly used in

A

rapid sequence induction

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68
Q

s/e of etomidate

A

adrenocortical insufficiency and metabolic acidosis

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69
Q

what are early symptoms of local anesthesia toxicity

A

CNS syx
restlessness, agitation and tinnitus

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70
Q

malignant hyperthermia is associated with what type of muscle relaxants

A

depolarising (succinylcholine)

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71
Q

reversal agents for non-depolarizing muscle relaxtants

A

neostigmine, edrophonium and sugammadex

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72
Q

pethidine is no longer present in the stepladder approach for pain management of malignant disease

A

True

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73
Q

umbilicus sensory nerve dermatome at which level

A

T10

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74
Q

which amino acid is used for catecholamines synthesis

A

Tyrosine

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75
Q

how to prevent refeeding syndrome

A

Calorie
delivery should be increased slowly and vitamins administered
regularly

Thiamine should be given before feeding

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76
Q

The largest volume of fluid absorption occurs in which part of the GI tract

A

Small bowel

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77
Q

Trace element deficiency associated with glucose intolerance and peripheral neuropathy

A

chromium deficiency

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78
Q

wound dehiscence percentage occurance in abdominal wounds

A

around 3%

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79
Q

wound dehiscence most commonly occur at post op day

A

5 to 8 POD

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80
Q

MCC of wound dehiscence

A

SSI

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81
Q

Criteria for day case surgery

A

Medical:
No upper age limit
ASA 1 & 2
HBA1C <8.5
controlled epilepsy
NOT on warfarin
BMI <40 for surface procedures
BMI <38 for lap surgery

Social:
good social circumstances

surgical:
surgeries up to 2 hours with expected postop pain managment and expected oral intake in a timely fashion

82
Q

Lucid interval is associated with

A

epidural hematoma

83
Q

Melanocytes are located in

A

the stratum basale of the epidermis

84
Q

berslow score

A

melanoma depth score that predicts prognosis

85
Q

risk factors for melanoma

A

dysplastic, atypical and large congenital nevi
xerdoerma pigmentosum
familial BK mole syndrome
fair skin complexion

86
Q

wich type of melanoma palms/soles of African Americans; subungual

A

acral lentiginous

87
Q

SLNB is done for melanoma if

A

> 1mm depth

88
Q

Desmoid tumors

A

Also called aggressive fibromatosis
benign but locally
invasive
most common location anterior abdominal wall

89
Q

bowen disease

A

SCC in situ associated with HPV

90
Q

contraindications to transplant

A
  1. active substance abuse
    2.uncontrolled infection
    3.Recent malignancy (except BCC SCC incidental RCC)
    4.active hep b,c
    5.non compliance
    6.severe cardiopulmonary disease
    7.active substance abuse
91
Q

hypermagnesemia syx

A

everything is depressed

92
Q

which parameter of ABG is not measured directly from the machine

A

bicarbonate concentration

93
Q

milk alkali syndrome can cause what acid base disturbance

A

metabolic alkalosis

94
Q

tumor lysis syndrome electrolyte abnormalities

A

hyperuricemia, hyperkalemia, hyperphosphatemia and HYPOcalcemia

95
Q

coagulation studies in vwf def will reveal

A

increased bleeding time
increased PTT
normal PT

96
Q

branchial cleft cyst are lined by

A

squamous epithelium

97
Q

effect of alcohol on parotid gland

A

bilateral gland enlargement

98
Q

preoperative localization imaging for parathyroid gland

A

high frequency u/s
MIBI
SPECT

of note gland weighing less than 500 mg show reduced concordance with imaging

99
Q

which type of thyroid cancer is often multicentric

A

papillary

100
Q

MC thyroid cancer after head and neck radiotherapy

A

papillary

101
Q

which thyroid CA is FNA useless

A

Follicular

102
Q

thyroid stores can maintain euthyroid state for how long

A

several weeks to months

103
Q

another name for toxic multinodular goiter

A

plummer disease

104
Q

structures the lie within the parotid gland superficial to deep

A

FRE
facial nerve
retromandibular vein
external caroid artery

105
Q

carotid triangle bounderaies

A

superior: posterior belly of digastric
lateral: sternocleidomastoid
medial: superior belly of omohyoid

106
Q

structures that are anatomically associated with submandibular gland

A

facial artery and vein
lingual nerve
hypoglossal nerve

107
Q

bone hunger

A

condition occurs after total thyroidectomy for graves disease

108
Q

postoperative thyroxine treatment is used

A

differentiated follicular and papillary thyroid CA

109
Q

the ansa cervicalis innervates

A

infrahyoid muscle

110
Q

platysma muscle is innervated by

A

the cervical branch of the facial nerve

111
Q

cricoid cartilage lies at which vertebral level

A

C6

112
Q

what pituitary hormones stain with acidic dye

A

GH, Prolactin

113
Q

regarding adrenocortical CA

A

50% are functioning
5 year survival 20%

114
Q

surgery is indicated for asymptomatic adrenal mass in

A

ominous CT scan characteristics (non-homogenous),
is > 4–6 cm, is functioning, is > 10 HU (Hounsfield Units), or is enlarging.

115
Q

other than breast CA
BRCA 2 is associated with what other cancers

A

prostate CA
pancreatic CA

116
Q

each breast is comprised of how many lobes

A

15-20 lobes

117
Q

micrometastasis L.N in breast ca

A

cancer cell up to 2mm

118
Q

which breast cancer subtype is frequently seen BRCA 1

A

medullary breast Ca

119
Q

atypical ribs

A

1,2
10,11,12

120
Q

Aortic hiatus content

A

aorta, thoracic duct and azygous vein

121
Q

esophageal hiatus content

A

esophagus, vagus nerve

122
Q

inferior vena cava hiatus contect

A

IVC, right phrenic nerve

123
Q

The trachea bifurcates at which level

A

T5

124
Q

how many segment does each lung have

A

Right 10
left 8

125
Q

curling ulcer found in

A

duodenum

126
Q

adenomyomatosis management

A

according to symptoms

127
Q

the most prevalent type of gallstones

A

mixed type containing cholesterol and bilirubin

128
Q

venous drainage of the caudate lobe

A

direct into IVC

129
Q

most of cholangiocarcinoma are located

A

extrahepatic

130
Q

screening for HCC in hep B patient is done how

A

via U/S Q6months

131
Q

ligaments of the liver

A

coronary ligament
right and left triangular ligament
falciform ligament
round ligament
ligamentum venosum

132
Q

alcoholic hepatitis AST/ALT ratio is

A

> 2

133
Q

which liver enzymes is specific for the liver

A

ALT

134
Q

venous drainage of the gallbladder

A

multiple cystic veins that drain into the portal vein

135
Q

dorsal pancreatic bud is embryological origin for

A

upper head of pancreas
body
tail

136
Q

In acute pancreatitis, amylase rise pattern

A

rise rapidly within three to six hours of the onset of symptoms and may remain elevated for up to five days.

137
Q

in acute pancreatitis,
lipase rise pattern

A

usually peaks at 24 hours with serum concentrations remaining elevated for eight to 14 days.

138
Q

difference between CCK and secretin of pancreas

A

CCK stimulate acinar cells
secretin stimulate ductal cells

139
Q

MCC of post splenectomy sepsis syndrome

A

splenectomy for hematological disease

140
Q

MC pathogen in post splenectomy sepsis syndrome

A

s.pneumonia

141
Q

gastrosplenic ligament contains what vessels

A

short gastric vessels

142
Q

type of colonic polyps in Juvenile polyposis syndrome

A

hamartomas

143
Q

ghrelin hormone is produced by

A

stomach

144
Q

MC site of carcinoid GI tumor

A

ileum then appendix

145
Q

MCC (name 2) of massive lower GI bleeding

A

angiodysplasia and diverticulosis

146
Q

Mass movements (powerful long standing contractions) are characteristic motility pattern of which part of the GI tract

A

Colon

147
Q

replaced left hepatic artery

A

hepatic artery arising from a left gastric artery

148
Q

Criteria for Patient Selection for Bariatric Surgery (Need All 4)

A

● Body mass index > 40 kg/m2 or body mass index > 35 kg/m2 with coexisting comorbidities
● Failure of nonsurgical methods of weight reduction
● Psychological stability
● Absence of drug and alcohol abuse

149
Q

Does not get better after obesity surgery

A

peripheral arterial disease

150
Q

percentage of DMT2 getting better after obesity surgery

A

80-90%

151
Q

MC site of curling ulcer

A

duodenum

152
Q

primary contracture of a skin graft means

A

the immediate reduction in the size of skin graft after it has been harvested, caused by passive recoil of elastin fibers in the dermis.

MORE COMMON WITh FTSG

153
Q
A
154
Q

the sequence of sensory recovery in a healing skin graft

A

pain then touch then temperature

155
Q

abdominal wall umbilical folds are formed by

A

median: urachus
medial: obliterated umbilical arteries
lateral: inferior epigastric vessels

156
Q

the protrusion and/or strangulation (without obstruction) of only part of the circumference of the intestine’s anti-mesenteric border through a rigid small defect of the abdominal wall is called

A

Richter’s hernia

157
Q

phlegmasia alba dolens

A

obliteration of the major deep venous channels and the collateral veins of the leg

158
Q

phlegmasia cerulea dolens

A

obliteration of the major deep venous channels with sparing of collateral veins

159
Q

MC cancer to metastasise to the thyroid

A

renal cell Ca

160
Q

the point of transition between the foregut and midgut

A

ampulla of duodenum

161
Q

MCC of child death

A

trauma

162
Q

urine output for baby <1 y/o

A

2-4cc/kg/hr

163
Q

MC affected lobe in Congenital lobar emphysema

A

LUL

164
Q

Most common congenital cysts of the mediastinum

A

Bronchiogenic cyst

165
Q

choledochal cysts pathogenesis

A

Caused by abnormal reflux of pancreatic enzymes into the biliary system in utero

166
Q

MC choledochal cyst type

A

type 1 fusiform

167
Q

cystic hygroma position in neck

A

usually lateral to the sternocleidomastoid

168
Q

MC diaphragmatic hernia type and its location

A

Bochdalek’s hernia – most common, usually located left side and posteriorly

169
Q

1 solid abdominal malignancy in children

A

NEUROBLASTOMA

170
Q

Most common malignant liver tumor in children

A

HEPATOBLASTOMA

171
Q

age of presentation for paediatric intussusception

A

3 months to 3 years

172
Q

most common type of TEF

A

Type C (Proximal esophageal atresia (blind pouch) and distal TE fistula)

173
Q

Morgagni’s hernia most commonly located

A

right side anteromedial

174
Q

maximum serum sodium correction for hyponatertremia over 24 hours

A

12meq/24 hours

175
Q

how to correct sodium in hyperglycemia

A

add 2 meq of Na for each 100mg/dl glucose above normal (100)

176
Q

qSOFA score

A

(respiratory rate >22/min, altered
mental status, and systolic blood pressure <100 mmHg)

177
Q

Clostridium
septicum is associated with what type of cancers

A

colon ca
hemtological ca

178
Q
A
179
Q

calcium absorption occurs primarily where in the GI tract

A

duodenum

180
Q

medication used in cancer related cachexia

A

megostorol (progesterone derivative)

181
Q

Poor glucose control is a manifestation of
deficiency of:

A

Chromium

182
Q

nutritional basis in TPN vs PPN

A

glucose for TPN
fat for PPN

because glucose makes product hyperosmolar a sammal vein cant handle

183
Q

treatment of HER2/neu overexpressing caners

A

Trastuzumab (herceptin)

184
Q

The effects of the chemotherapy
regimen on wound healing lasts for

A

6 months

185
Q

reversal agent for apixaban and rivaroxaban

A

Andexanet alpha

186
Q

Silver
sulfadiazine does NOT cover which microorganism

A

pseudomonas aeruginosa

187
Q

CYP450 inducers examples

A

barbiturates, rifampin, omeprazole, prednisone, phenytoin

188
Q

one antibiotic that has same bioavailability in both oral and iv route

A

ciprofloxacin

189
Q

prefered neuromuscular agent for RSI

A

etomidate

190
Q

most important risk factor for etomidate

A

acute adrenal insufficiency

191
Q

the Tx of cyanide poisoning following the administration of nitroprusside

A

The initial treatment is inhaled amyl nitrite followed by intravenous sodium nitrite

192
Q

classical antibiotic associated with c.diff

A

clindamycin

193
Q

which lab parameter is mostly associated with an increased risk of
pulmonary-related postoperative complications

A

albumin

194
Q

advantage of postpyloric feeding in ICU/diabetic patient who have delayed gastric emptying

A

lower rates of pneumonia

195
Q

risk factors for the development
of postoperative pulmonary complications

A

age>50
COPD
congestive heart
ASA >2,
serum albumin< 3.5 g/L, obstructive sleep apnea,
pulmonary HTN ,
smoking

196
Q

what antibiotic is added in necrotizing soft tissue infection and why

A

Clindamycin has been shown to limit
toxin production, , and can potentially reduce inflammatory cytokine
release.

197
Q

The highest risk of ureteral injury is during
which abdominal surgery

A

APR
abdominoperineal resection

198
Q

what K time indicated in TEG

A

refers to the time to fibrin cross linking and an elevated K
time indicates a deficiency of fibrinogen

199
Q

cryoprecipitate contains a low concentration of which factor

A

XI

200
Q

the
most common inherited condition predisposing patients
to arterial thrombosis

A

homocystinuria

201
Q
A

Residency (6 decks)

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