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Fiser > Practice Tests > Flashcards

Practice Tests Flashcards

1
Q

Abdominal compartment syndrome is defined as sustained intra abdominal pressure > ___ mmHg a/w new organ dysfunction or failure

A

20 mm Hg. Pressure this high is an indication of continuous monitoring

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2
Q

What is the treatment of type 3 choledochal cyst?

A

Trans-duodenal approach with either marsupialization or excision of the cyst

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3
Q

What is the preferred imaging to diagnose carotid body tumor?

A

CTA

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4
Q

What is treatment for wandering spleen?

A

Splenopexy. Splenectomy if spleen is infarcted

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5
Q

Pre-albumin’s half life is ____, and is the most commonly used acute indicator of ______

A

2 days

nutritional status

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6
Q

What is the hallmark electrolyte disturbance a/w refeeding syndrome?

A

Hypo-phosphatemia

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7
Q

_____ is required by nitric oxide synthase

A

L-arginine

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8
Q

Treatment for atypical ductal hyperplasia

A

excisional biopsy

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9
Q

After two years, ____ is the driving force for late bypass failure

A

atherosclerosis

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10
Q

____ is typically the reason for bypass graft failure between two months and two years

A

intimal hyperplasia

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11
Q

Bypass graft failure within 30 days of surgery is typically due to _____

A

a technical complication

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12
Q

____ - the most common primary cardiac tumor in adults

____ the most common primary cardiac tumor in children

A

Myxomas

Rhabdomyomas

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13
Q

_____ is the treatment of choice for simple intersphincteric fistula in ano that do not involve the external anal sphincter

A

Fistulotomy

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14
Q

____ is the treatment used for these type of fistulas

A

Fistulas transversing the external anal sphincter, to preserve continence

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15
Q

Aggressive, high grade lymphoma of ____ cell origin is most common lymphoma in the AIDS patient

A

B cell lymphoma

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16
Q

IgA (does/doesn’t) activate complement –> cell mediated opsonization

A

Does not activate compliment and does not enhance cell mediated opsonization

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17
Q

The two most important prognostic indicators for esophageal cancer are:

A

depth of tumor penetration and nodal involvement

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18
Q

Treatment for undifferentiated spindle cell tumor (malignant fibrous histiocytoma of bone)

A

neoadjuvant chemotherapy and excision with wide margins

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19
Q

Overall, the _____ provides the best route for esophageal substitutes during esophageal replacement

A

posterior mediastinum

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20
Q

Parameters used to calculate Ranson score 48 hours after admission

  • HCT decrease > ___
  • BUN increase > ___
  • Ca < ___
  • PaO2 < ___
  • Base deficit > ___
  • Fluid requirement > ___
A
  • HCT decrease > 10
  • BUN increase > 5
  • Ca < 8
  • PaO2 < 60
  • Base deficit > 4
  • Fluid requirement > 6L
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21
Q

How is surgical reduction of intussusception performed?

A

it is reduced by squeezing the mass retrograde from distal to proximal. Also perform an appendectomy.

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22
Q

Which compartment of the lower leg is most susceptible to compartment syndrome?

A

Anterior

Anterior, lateral, superficial posterior, deep posterior

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23
Q

Best treatment after a blunt trauma leads to a distal pancreatic parenchymal transection

A

Distal pancreatectomy

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24
Q

Treatment - large mesenteric cyst

A

Resection of cyst, wedge of mesentery, associated intestine, with primary end to end anastomosis

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25
Q

Treatment - small mesenteric cyst

A

laparoscopic excision without bowel resection

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26
Q

wait time until interval appendectomy

A

6-8 weeks

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27
Q

Treatment options- actinic keratosis

A
  • cautery and destruction
  • cautery and curettage
  • cryotherapy

(Actinic keratosis is a precursor to SCC)

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28
Q

What is the most common location of the sinoatrial node?

A

The junction of the right atrium and SVC

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29
Q

Newborn baby AXR - distended abdomen at birth, multiple dilated bowel loops of varying sizes, bubbly or ground glass appearance in RLQ, few air fluid levels. This is classic for _______

A

Meconium Ileus

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30
Q

Do gastric hyperplastic polyps have malignant potential?

A

No. Very common in the normal population. No increased risk of gastric cancer.

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31
Q

Treatment for DVT 2/2 upper extremity central venous line

A

Remove catheter
Heparin therapy
long term oral anticoagulants for 3-6 months

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32
Q

Differentiation between acute thrombosis and chronic venous obstruction. Recent thrombi are ____-echoic, whereas chronic obstruction are ____-echoic compared to surrounding tissue

A

Recent thrombi are non-echoic or hypo-echoic

Chronic thrombi are hyper-echoic

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33
Q

The histologic characteristics of ____ rejection include infiltration of lymphocytes, plasma cells, eosiniphils, and neutrophils

A

acute rejection

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34
Q

Lap or open chole p which leads to more benign bile duct strictures

A

lap chole

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35
Q

What is the best way to image a thoraco-abdominal aortic aneurysm

A

CTA

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36
Q

Which of the following is not a danger-associated molecular pattern (DAMP), the endogenous form of pathogen-associated molecular patterns (PAMPS), which represent danger signals

  • Soluble Toll-like receptor 2
  • Uric Acid
  • high mobility group box 1 (HMGB1)
  • S100
A

Soluble toll like receptor 2

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37
Q

What muscles are encountered (3) from skin to thyroid as you perform the exposure for a thyroidectomy?

A
  • Platsyma
  • Sterno-hyoid
  • Sterno-thyroid
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38
Q

What are the most common post op complications after ileostomy reversal (2)?

A
  • Small bowel obstruction

- wound infection

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39
Q

What is the role of protease serine 1 (PRSS1)?

A

This is a protease inhibitor found in the pancreas. Prevents autodigestion. A PRSS1 genetic mutation is an important cause of familial recurrent pancreatitis

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40
Q

What percentage of patients have resolution of pseudotumor cerebri following bariatric surgery?

A

100%

41
Q

What is the Baux score (burns)?

A

Age + TBSA% (2nd degree+) = mortality risk

42
Q

Intra-aortic balloon pumps _____ (inflate/deflate) during diastole to increase myocardial perfusion in cardiogenic shock, to help push blood through the dilated coronary vessels.

A

inflate

43
Q

In the middle of a laparoscopic procedure, possibly after rapid infusion of blood products, the anesthesiologist informs you of sudden bradycardia, a drop in BP not responding to IVF, a “mill-wheel” murmur, and inferior ST-segment changes on the monitor. What is the diagnosis?

A

Venous air embolism

44
Q

Management - venous air embolism (4)

A
  • release of the pneumo-peritoneum
  • place patient in steep Trendelenburg
  • place patient in left lateral decubitus position
  • insert central line to aspirate air from right atrium
45
Q

67F has ovarian cancer that involves both ovaries but does not extend into pelvis or abdomen. What is her stage?

A

Stage I - can involve both ovaries

46
Q

After creation of an AV fistula, hand pain and ischemia are most likely related to _____ phenomenon

A

Steal
Compression of the access may result in relief of symptoms and return of radial pulse, which is diagnostic of access-induced steal syndrome

47
Q

Where in the pancreas are insulinomas most commonly located?

A

Evenly distributed throughout the pancreas

48
Q

Where in the pancreas are gastrinomas located?

A

Passero’s triangle

49
Q

Large intestinal flora ferment oligosaccharides, that (can/cannot) be digested, into _______. The latter is used as fuel for _____

A
  • cannot be digested
  • short chain fatty acids
  • colonocytes
50
Q

_____ Toxicity - tinnitus, numbness/tingling of the lips and mouth, slurred speech, confusion, seizures, widened PR interval, widened QRS, sinus tachycardia

A

lidocaine toxicity

51
Q

Cardiac effects of lidocaine toxicity (3)

A
  • widened PR interval
  • widened QRS
  • sinus tachycardia
52
Q

Management of medullary thyroid cancer

A

total thyroidectomy with bilateral central neck dissection (level 6 lymph nodes).

If there is evidence of metastasis to lateral neck lymph nodes, add lateral neck dissection to that side

53
Q

Medullary thyroid cancer is associated with elevated levels of _____

A

calcitonin

54
Q

Medullary thyroid cancer is associated with which hereditary syndromes?

A

MENIIA and MENIIB

MENIIA - perform prophylactic total thyroidectomy before age 5
MENIIB - perform total thyroidectomy before age 1

55
Q

The correct order that cells arrive to acute tissue injury (5)

A
  1. platelets
  2. neutrophils
  3. macrophages
  4. lymphocytes
  5. fibroblasts
56
Q

What happens to maternal blood pressure during the first two trimesters?

A

It diminishes, due to a decrease in systemic vascular resistance

57
Q

Which transplant drug has this method of action?

Inhibits de novo purine synthesis, which inhibits growth of T cells

A

Mycophenolate (MMF, CellCept)

58
Q

Which transplant drug has this method of action?

Inhibits inflammatory cells (macrophages) and genes for cytokine synthesis (IL-2 most important

A

steroids - prednisone, solu-medrol

59
Q

Which transplant drug has this method of action?

Binds cyclophilin protein; CSA-cyclophilin complex, which results in decreased cytokine synthesis

A

Cyclosporin (CSA)

60
Q

Which transplant drug has this method of action?

Binds FK-binding protein, inhibits calcineurin, thus inhibiting T cell signal transduction and IL-2 production

A

Tacrolimus

61
Q

Which transplant drug has this method of action?

Binds FK binding protein, inhibits mTOR –> inhibits T and B cell response to IL-2

A

Sirolimus (Rapamycin)

62
Q

Goal trough - Cyclosporin

A

200-300

63
Q

Cyclosporin undergoes ______ metabolism and _____ excretion

A

Undergoes hepatic metabolism, biliary excretion

64
Q

Goal trough - Tacrolimus

A

10-15

65
Q

Major side effect - Sirolimus/ Rapamycin

A

interstitial lung disease

66
Q

Which transplant drug has this method of action?

Equine or rabbit polyclonal antibodies against T cell antigens

A

Anti-thymocyte globulin

67
Q

Major side effect - anti-thymocyte globulin

How can this be prevented?

A

Cytokine release syndrome

  • fevers, chills, pulmonary edema, shock
  • steroids and drugs used to try and prevent this
68
Q

What factors does the PT measure? (5)

A

1, 2, 5, 7, 9

69
Q

Does the PT measure the extrinsic or intrinsic pathway?

A

Extrinsic pathway

70
Q

What factors does the aPTT measure? (8)

A

1, 2, 5, 8, 9, 10, 11, 12

71
Q

What is the most important determinant in the PT?

A

Factor 7

72
Q

Elevated trough levels are adjusted by ______ (decreasing the dose or decreasing the frequency)

A

decreasing the frequency

trough levels that are too low are adjusted by increasing the frequency of the dose

73
Q

Peak levels that are too high are adjusted by ______ (decreasing the dose or decreasing the frequency)

A

decreasing the dose

Peak levels that are too low can be adjusted by increasing the amount of the dose

74
Q

What organism most commonly causes acute lymphangitis. Treatment?

A

Group A Strep. Best treated with a PCN

75
Q

What is the treatment for Hemophilia A?

A

Cryoprecipitate.

It is rich in factor 8 and fibrinogen and will help coagulation in these patients.

76
Q

How do you stop warfarin-induced skin necrosis?

A

Stop warfarin
give vitamin K
systemic heparin therapy

77
Q

_____ is a potential infectious etiology found in HIV positive patients with bowel perforation

A

CMV

78
Q

Von Willebrand’s disease is associated with normal or abnormal platelets?

A

normal platelets

79
Q

Von Willebrand’s disease - associated with normal or prolonged bleeding time?

A

Prolonged bleeding time

80
Q

What is the antidote to ethylene glycol poisoning?

A

Fomepizole

81
Q

Treatment of methemoglobinemia?

A

Methylene blue

82
Q

______ can be used to correct intra-op bleeding in patients with ESRD

A

DDAVP

83
Q

Potential side effect - mafenide acetate

A

metabolic acidosis

84
Q

potential side effect - silver nitrate

A

hyponatremia and methemoglobinemia

85
Q

potential side effect - silvadine (silver sulfadiazine)

A

transient neutropenia

86
Q

Breast - stereotactic needle biopsy reveals columnar cell lesions with atypia. Next step?

A

Proceed with surgical excision - frequent assoication with tubular carcinoma

87
Q

injury to the thoracododorsal nerve and the muscle it innervates

A

weakened arm pull-ups and adduction.

Innervates the latissimus dorsi muscle

88
Q

injury to the long thoracic nerve and the muscle it innervates

A

winging of the scapula, inability to raise arm above shoulder

serratus anterior

89
Q

injury to the intercostobrachial nerve

A

numbness and pain of the upper inner arm

90
Q

What is the significance of LCIS? Is it pre-malignant?

A

It is a tumor marker for breast cancer but it is not a premalignant lesion

Therefore, negative margins are not required when performing an excisional biopsy

91
Q

Why is the upper outer quadrant of the breast the most frequent site of both benign and malignant breast disease?

A

abundance of epithelial tissue

92
Q

LCIS is associated with the development of what kind of breast cancer?

A

Ductal cancer

93
Q

What medicine can you give patients with LCIS?

A

tamoxifen - has been shown to reduce the risk of developing cancer

94
Q

BI-RADS 2 on mammogram

A

benign

95
Q

BIRADS 1 on mammogram

A

negative for malignancy

96
Q

BIRADS 0 on mammogram

A

incomplete - workup requires further evaluation

97
Q

What is the relevance disease? phenylethanolamine-N-methyltransferase (PMNT) -

A

Pheochromocytoma

Converts norepinephrine to epinephrine

98
Q

_____ is the most important component of the TNM staging for well differentiated thyroid cancer

A

Age

Stage 3 and 4 do not exist for patient under 45 with well differentiated thyroid cancer

Fiser (4 decks)

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