Past papers (rowad book) Flashcards
anti inflammatory cytokines
IL-10, IL-4, TGF-beta, IL-13
high levels of carbamino compounds is associated with a … shift in the o2-hb dissociation curve
right
hypovolemic initial physiological response is
increase in catecholamines
why does blood transfusion cause left shift in o2-hb curve
decrease 2-3 DPG
why does sickle cell anemia causes a left shift in o2-hb curve
HbF
IL-1 is primarily produced by
macrophages
factors that can affect the accuracy of pulse oximetry
1.nail polish
2. methemoglobinemia
3. dark skin
4.carboxyhemoglobin
5.Ambient light (eg surgical lights)
6. very low O2 sat levels
only type of shock that has an increased Cardiac output
Distributive
ETCO2 in PE is
decreased
antidote for beta blocker overdose
glucagon (through increasing cAMP independent of beta adrenergic receptors)
pulse pressure is only increased in what type of shock
distributive
MCC of neurogenic shock
spinal cord injuries
Sepsis criteria
SIRS+ source of infection
severe Sepsis criteria
Sepsis+
Lactic acidosis, SBP <90 or SBP drop ≥40 mm Hg of norma
Septic shock
Severe sepsis + hypotension not responding to fluid
The most common sources of infection in septic shock
pneumonia
UTI
above what level does spinal cord injury lead to neurogenic shock
Above T6
electrolyte abnormalities following massive blood transfusion
Hypocalcemia (MC)
Hyperkalemia
Hypomagnesemia
Most common blood product associated with TRALI
FFP
Most common blood product associated with allergic reaction
FFP
(reaction to donor antigens in plasma)
Cryoprecipitate stored at what temperature
below -18C
platelets stored at what temperature
22-24C
PRBCs stored at what temperature
2-10C
FFP stored at what temperature
below -30C
In anesthetized patients, transfusion reactions may present as
Diffuse bleeding
Most efficient and common method to decrease incidence of Febrile nonhemolytic transfusion reaction
filtration of blood products
blood product with the highest transfusion-transmitted infectious risk
platelets
what acid-base disorder occurs following massive blood transfusion
Metabolic alkalosis due to conversion of citrate to HCO3
Prothrombin complex concentrate contains
factor 1972
lectin complement pathway is activated by
This pathway is initiated by the binding of mannose-binding lectin (MBL), collectin 11, and ficolins to microbial surface oligosaccharides and acetylated residues, respectively.
keloid on histopathology
chronic inflammation, marked angiogenesis and a large amount of collagen
ischial pressure ulcers is common in
paraplegic patients using wheelchair
Most common areas for keloid formation
ear lobe, deltoid, parasternal and upper back
firm discrete nodule at the site of previous surgery
granuloma
alginate dressing main function in wounds
absorb exudate and form gel like barrier
most powerful chemotactic factor for fibroblasts
PDGF
the greater the angle of z-plasty the greater the … of scar
Length
everted edge ulcer is seen in
squamous cell CA
punched out edge ulcer is seen in
syphilis, Diabetic ulcer
undermined ulcer edge is seen in
Tb, bed sore
bone reaches maximal tensile strength after
6 months
the two most important cells in wound healing
macrophages and fibroblasts
the MC pathogen associated with cat bites
pasteurella multocida
MC organism associated with central line infections
coagulase negative staph (staph epidermis)
exotoxin are
peptides
exotoxin are produced mainly by
gram positive
antibiotic of choice for actinomyces
Penicillin G
MC organism cellulitis
beta hemolytic streptococcus
c. tetani is
gram positive spore forming rod
polyGlactin
Vicryl
polyDioxanone
PDS
polyGlycaprone
Monocryl
the easiest suture to knot
silk
the highest tissue reaction of all absorbable sutures
Catgut
current type used in bipolar and monopolar devices
AC (alternating current)
The most common vessel to be injured during laparoscopic procedure
Right common iliac artery
Tumor marker for GIST
CD117 (c-KIT)
cell cycle phases
G1 (normal cell activity)
S (DNA synthesis)
G2 (prepare mitosis)
M (Mitosis)
Atypia is reversible or not
it is reversible if underlying cause is addressed
alcohol based preparations are not effective againt
c.diff
preoperative assessment should be done … weeks before surgery
2-4 weeks
recommended time of holding for ACR ARB and diuretics before surgery
stop day before surgery
recommended time of holding OCPs before surgery
stop 4 weeks before surgery
halothane hepatitis clinical picture
fever, eosinophilia, jaundice and elevated LFT
which inhalational agent can cause seizure
enflurane
propofol is contraindicated in
patients with egg allergy
pregnancy
parkinson
Etomidate is mostly used in
rapid sequence induction
s/e of etomidate
adrenocortical insufficiency and metabolic acidosis
what are early symptoms of local anesthesia toxicity
CNS syx
restlessness, agitation and tinnitus
malignant hyperthermia is associated with what type of muscle relaxants
depolarising (succinylcholine)
reversal agents for non-depolarizing muscle relaxtants
neostigmine, edrophonium and sugammadex
pethidine is no longer present in the stepladder approach for pain management of malignant disease
True
umbilicus sensory nerve dermatome at which level
T10
which amino acid is used for catecholamines synthesis
Tyrosine
how to prevent refeeding syndrome
Calorie
delivery should be increased slowly and vitamins administered
regularly
Thiamine should be given before feeding
The largest volume of fluid absorption occurs in which part of the GI tract
Small bowel
Trace element deficiency associated with glucose intolerance and peripheral neuropathy
chromium deficiency
wound dehiscence percentage occurance in abdominal wounds
around 3%
wound dehiscence most commonly occur at post op day
5 to 8 POD
MCC of wound dehiscence
SSI
Criteria for day case surgery
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
Lucid interval is associated with
epidural hematoma
Melanocytes are located in
the stratum basale of the epidermis
berslow score
melanoma depth score that predicts prognosis
risk factors for melanoma
dysplastic, atypical and large congenital nevi
xerdoerma pigmentosum
familial BK mole syndrome
fair skin complexion
wich type of melanoma palms/soles of African Americans; subungual
acral lentiginous
SLNB is done for melanoma if
> 1mm depth
Desmoid tumors
Also called aggressive fibromatosis
benign but locally
invasive
most common location anterior abdominal wall
bowen disease
SCC in situ associated with HPV
contraindications to transplant
- 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
hypermagnesemia syx
everything is depressed
which parameter of ABG is not measured directly from the machine
bicarbonate concentration
milk alkali syndrome can cause what acid base disturbance
metabolic alkalosis
tumor lysis syndrome electrolyte abnormalities
hyperuricemia, hyperkalemia, hyperphosphatemia and HYPOcalcemia
coagulation studies in vwf def will reveal
increased bleeding time
increased PTT
normal PT
branchial cleft cyst are lined by
squamous epithelium
effect of alcohol on parotid gland
bilateral gland enlargement
preoperative localization imaging for parathyroid gland
high frequency u/s
MIBI
SPECT
of note gland weighing less than 500 mg show reduced concordance with imaging
which type of thyroid cancer is often multicentric
papillary
MC thyroid cancer after head and neck radiotherapy
papillary
which thyroid CA is FNA useless
Follicular
thyroid stores can maintain euthyroid state for how long
several weeks to months
another name for toxic multinodular goiter
plummer disease
structures the lie within the parotid gland superficial to deep
FRE
facial nerve
retromandibular vein
external caroid artery
carotid triangle bounderaies
superior: posterior belly of digastric
lateral: sternocleidomastoid
medial: superior belly of omohyoid
structures that are anatomically associated with submandibular gland
facial artery and vein
lingual nerve
hypoglossal nerve
bone hunger
condition occurs after total thyroidectomy for graves disease
postoperative thyroxine treatment is used
differentiated follicular and papillary thyroid CA
the ansa cervicalis innervates
infrahyoid muscle
platysma muscle is innervated by
the cervical branch of the facial nerve
cricoid cartilage lies at which vertebral level
C6
what pituitary hormones stain with acidic dye
GH, Prolactin
regarding adrenocortical CA
50% are functioning
5 year survival 20%
surgery is indicated for asymptomatic adrenal mass in
ominous CT scan characteristics (non-homogenous),
is > 4–6 cm, is functioning, is > 10 HU (Hounsfield Units), or is enlarging.
other than breast CA
BRCA 2 is associated with what other cancers
prostate CA
pancreatic CA
each breast is comprised of how many lobes
15-20 lobes
micrometastasis L.N in breast ca
cancer cell up to 2mm
which breast cancer subtype is frequently seen BRCA 1
medullary breast Ca
atypical ribs
1,2
10,11,12
Aortic hiatus content
aorta, thoracic duct and azygous vein
esophageal hiatus content
esophagus, vagus nerve
inferior vena cava hiatus contect
IVC, right phrenic nerve
The trachea bifurcates at which level
T5
how many segment does each lung have
Right 10
left 8
curling ulcer found in
duodenum
adenomyomatosis management
according to symptoms
the most prevalent type of gallstones
mixed type containing cholesterol and bilirubin
venous drainage of the caudate lobe
direct into IVC
most of cholangiocarcinoma are located
extrahepatic
screening for HCC in hep B patient is done how
via U/S Q6months
ligaments of the liver
coronary ligament
right and left triangular ligament
falciform ligament
round ligament
ligamentum venosum
alcoholic hepatitis AST/ALT ratio is
> 2
which liver enzymes is specific for the liver
ALT
venous drainage of the gallbladder
multiple cystic veins that drain into the portal vein
dorsal pancreatic bud is embryological origin for
upper head of pancreas
body
tail
In acute pancreatitis, amylase rise pattern
rise rapidly within three to six hours of the onset of symptoms and may remain elevated for up to five days.
in acute pancreatitis,
lipase rise pattern
usually peaks at 24 hours with serum concentrations remaining elevated for eight to 14 days.
difference between CCK and secretin of pancreas
CCK stimulate acinar cells
secretin stimulate ductal cells
MCC of post splenectomy sepsis syndrome
splenectomy for hematological disease
MC pathogen in post splenectomy sepsis syndrome
s.pneumonia
gastrosplenic ligament contains what vessels
short gastric vessels
type of colonic polyps in Juvenile polyposis syndrome
hamartomas
ghrelin hormone is produced by
stomach
MC site of carcinoid GI tumor
ileum then appendix
MCC (name 2) of massive lower GI bleeding
angiodysplasia and diverticulosis
Mass movements (powerful long standing contractions) are characteristic motility pattern of which part of the GI tract
Colon
replaced left hepatic artery
hepatic artery arising from a left gastric artery
Criteria for Patient Selection for Bariatric Surgery (Need All 4)
● 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
Does not get better after obesity surgery
peripheral arterial disease
percentage of DMT2 getting better after obesity surgery
80-90%
MC site of curling ulcer
duodenum
primary contracture of a skin graft means
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
the sequence of sensory recovery in a healing skin graft
pain then touch then temperature
abdominal wall umbilical folds are formed by
median: urachus
medial: obliterated umbilical arteries
lateral: inferior epigastric vessels
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
Richter’s hernia
phlegmasia alba dolens
obliteration of the major deep venous channels and the collateral veins of the leg
phlegmasia cerulea dolens
obliteration of the major deep venous channels with sparing of collateral veins
MC cancer to metastasise to the thyroid
renal cell Ca
the point of transition between the foregut and midgut
ampulla of duodenum
MCC of child death
trauma
urine output for baby <1 y/o
2-4cc/kg/hr
MC affected lobe in Congenital lobar emphysema
LUL
Most common congenital cysts of the mediastinum
Bronchiogenic cyst
choledochal cysts pathogenesis
Caused by abnormal reflux of pancreatic enzymes into the biliary system in utero
MC choledochal cyst type
type 1 fusiform
cystic hygroma position in neck
usually lateral to the sternocleidomastoid
MC diaphragmatic hernia type and its location
Bochdalek’s hernia – most common, usually located left side and posteriorly
1 solid abdominal malignancy in children
NEUROBLASTOMA
Most common malignant liver tumor in children
HEPATOBLASTOMA
age of presentation for paediatric intussusception
3 months to 3 years
most common type of TEF
Type C (Proximal esophageal atresia (blind pouch) and distal TE fistula)
Morgagni’s hernia most commonly located
right side anteromedial
maximum serum sodium correction for hyponatertremia over 24 hours
12meq/24 hours
how to correct sodium in hyperglycemia
add 2 meq of Na for each 100mg/dl glucose above normal (100)
qSOFA score
(respiratory rate >22/min, altered
mental status, and systolic blood pressure <100 mmHg)
Clostridium
septicum is associated with what type of cancers
colon ca
hemtological ca
calcium absorption occurs primarily where in the GI tract
duodenum
medication used in cancer related cachexia
megostorol (progesterone derivative)
Poor glucose control is a manifestation of
deficiency of:
Chromium
nutritional basis in TPN vs PPN
glucose for TPN
fat for PPN
because glucose makes product hyperosmolar a sammal vein cant handle
treatment of HER2/neu overexpressing caners
Trastuzumab (herceptin)
The effects of the chemotherapy
regimen on wound healing lasts for
6 months
reversal agent for apixaban and rivaroxaban
Andexanet alpha
Silver
sulfadiazine does NOT cover which microorganism
pseudomonas aeruginosa
CYP450 inducers examples
barbiturates, rifampin, omeprazole, prednisone, phenytoin
one antibiotic that has same bioavailability in both oral and iv route
ciprofloxacin
prefered neuromuscular agent for RSI
etomidate
most important risk factor for etomidate
acute adrenal insufficiency
the Tx of cyanide poisoning following the administration of nitroprusside
The initial treatment is inhaled amyl nitrite followed by intravenous sodium nitrite
classical antibiotic associated with c.diff
clindamycin
which lab parameter is mostly associated with an increased risk of
pulmonary-related postoperative complications
albumin
advantage of postpyloric feeding in ICU/diabetic patient who have delayed gastric emptying
lower rates of pneumonia
risk factors for the development
of postoperative pulmonary complications
age>50
COPD
congestive heart
ASA >2,
serum albumin< 3.5 g/L, obstructive sleep apnea,
pulmonary HTN ,
smoking
what antibiotic is added in necrotizing soft tissue infection and why
Clindamycin has been shown to limit
toxin production, , and can potentially reduce inflammatory cytokine
release.
The highest risk of ureteral injury is during
which abdominal surgery
APR
abdominoperineal resection
what K time indicated in TEG
refers to the time to fibrin cross linking and an elevated K
time indicates a deficiency of fibrinogen
cryoprecipitate contains a low concentration of which factor
XI
the
most common inherited condition predisposing patients
to arterial thrombosis
homocystinuria
surface anatomy (vertebral level) of thyroid gland
C5-T1
hypothyroidism effect of lipid levels
causes hyperlipedemia
The four infrahyoid (strap) muscles are the
sternohyoid, sternothyroid, thyrohyoid and omohyoid muscles
which blood test can anticipate bone hunger following surgery for primary hyperparathyroidism
alkaline phophatase
function of the temporalis muscle
anterior fibres move the mandible forward
posterior fibres move the mandible backward
The space ABOVE the false vocal cords is called
vestibule
The most sensitive test for pheochromocytoma
Plasma free metanephrines followed by 24 hour urinary metanephrines and VMA
Mitotane drug
Adrenal-lytic drug used in adrenocortical Ca for residual, recurrent or metastatic disease
percentage of adrenocortical Ca that are functioning
50%
which BRCA mutation is associated with pancreatic or prostate cancer
BRCA 2
surface anatomy of the breast
The breast is located on the anterior thoracic wall. It extends horizontally from the lateral border of the sternum to the mid-axillary line. Vertically, it spans between the 2nd and 6th costal cartilages. It lies superficially to the pectoralis major and serratus anterior muscles.
arterial supply of the lateral portion of the breast
lateral thoracic artery
thoracoacromial artery
drug induced gynecomastia are more commonly bilateral vs unilateral ?
unilateral
which breast cancer type is frequently observed in BRCA 1
medullary breast cancer
characterised by high grade tumor cell and lymphocytic infiltrates
surgery for PTX
recurrence, persistent air leak > 5 days, non-reexpansion
(despite 2 chest tubes), high-risk profession (airline pilot, diver, mountain
climber), patients who live in remote areas, tension PTX, hemothorax,
bilateral PTX, previous pneumonectomy, large bleb on CT scan
The most common presentation of thoracic outlet syndrome
neurogenic TOS
nerve provides sensation to the nipple areolar complex
The lateral cutaneous branch of the fourth intercostal nerve
rebleeding rate from untreated esophageal varices is about
70%
Glucagon like peptide 1 function
Glucagon-like peptide-1 (GLP-1) released from gut enteroendocrine cells controls meal-related glycemic excursions through augmentation of insulin and inhibition of glucagon secretion
small bowel fluid secretion amount/day
2000-3000cc
saliva secretion/day
1000-1500 cc
Mass movement is a characteristic motility pattern of which part of the GI tract
colon
Another name for false diverticulum
pulsion diverticulum
mc type of gallstones
mixed stones
most gallstones show on xray true or false?
false
blood test used to predict chronicity following acute hep B infection
HBeAg
function of ALT AST
amino acid metaolism
as gallstone size increases the risk of GB Ca…
increases
what constitutes un unresectable pancreatic adenocarcinoma
- Invasion of retroperitoneum
- Unreconstructable portal vein or SMV involvement
- > 180-degree contact with SMA or celiac artery
- Metastases to peritoneum, omentum, liver (MC site of metastasis), or other distant sites
- Metastases to celiac or SMA nodal system (nodal systems outside area of resection)
most potent stimulator for pancreatic acinar cell (enzyme) secretion
CCK
median umbilical ligament is a derivative of
urachus
medial umbilical ligaments are derivative of
umbilical arteries
common peroneal nerve is closely associated to what part of bone
neck of fibula
perineal hematoma following straddle injury is caused by
rupture of corpus spongiosum
which tissue solely heals by repair rather than regeneration
skin
least cross allergy with penicillin
erythromycin
difference in degradation between synthetic and natural absorbable suture material
synthetic absorbable are degraded by hydrolysis while natural absorbable are degraded proteolytic enzymes
sutures that never degrades
prolene
steel
polyester
which measure is prefered for the RAPID reduction in ICP following head trauma?
Mannitol administration
