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1
Q

LARP - posterior vagus becomes what? anterior vagus becomes what?

A

posterior - celiac plexus, criminal nerve of Grassi

anterior - liver and biliary tree, nerve of laterjet

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2
Q

resting pressure of upper esophageal sphincter

A

60mmHg (cricopharyngeal mm)

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3
Q

resting pressure of LES, and what are the layers of the “sphincter”?

A

15mmHg, intrinsic mm of the esophagus, sling fibers of the cardia, crura of the diaphragm, GE junction

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4
Q

treatment of achalasia? what if high surgical risk?

A

pneumatic dilation of LES, heller myotomy (5cm onto esophagus, 2cm onto stomach), POEM
- high surgical risk –> botox, nitrates and CCBs

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5
Q

treatment of DES (early distal contraction)

A
  1. control of GERD symptoms, CCBs
  2. botox
  3. POEM
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6
Q

treatment of nutcracker syndrome

A
  1. control of GERD, CCBs
  2. TCAs, botox
  3. POEM
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7
Q

GERD LES pressure? Demeester score?

A

<4mmHg. >14 demeester

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8
Q

GERD with BMI >35? esophageal motility disorder?

A

Roux en Y.

Toupet (posterior 270 wrap)

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9
Q

size of bougie for a wrap

A

56 or 60cm

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10
Q

barretts esophagus treatment

A
  • always consider antireflux surgery
  • nondysplastic - medical therapy, surveillance endoscopy every 3-5 years
  • low grade dysplasia - medical therapy vs endoscopic eradicaton, surveillance every 6-12mo
  • high grade dysplasia - endoscopic eradication therapy, surveillance every 3 mo
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11
Q

bleeding during hiatal hernia repair

A

replaced L hepatic

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12
Q

GDA comes off of? R gastric comes off?

A

common hepatic

proper hepatic

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13
Q

layers of the stomach

A

mucosa (lamina propria, muscularis propria)
submucosa
muscularis externa (oblique, circular, longitudinal)
serosa

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14
Q

Secretions

  • parietal cells (stim, inhibit)
  • G cells (stim, inhibit)
  • ECL (stim, inhibit)
  • D cells (stim, inhibit)
  • Chief cells (stim)
A

parietal cells - HCL + IF - stimulated by Ach, gastrin, histamine. inhibited by SS, prostaglandins (PGE1), secretin, CCK.
G cells - gastrin - stimulate by AA, Ach, food (alkaline). inhibited by. inhibited by H+ in the duodeun
ECL- histamine - stimulated by Ach, gastrin. inhibited by SS, H2 blockers
D cells - SS - stimulated by acid. inhibited by vagus
Chief cells - pepsinogen (becomes pepsin by HCl). stimulated by Ach

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15
Q

PUD types and treatment

A 
MAAM
1- lesser curve
2 - 2 ulcers
3 - "pre"
4 - "at the door" (cardia)
5 - anywhere (NSAIDS)
tx: antrectomy + vagotomy and BI/II. perforation --> avoid graham patch unless unstable
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16
Q

metabolic changes with gastric outlet obstruction

A

hypokalemic, hypochloremic, metabolic alkalosis

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17
Q

Dx and tx:

  • alkaline reflux gastritis dx and tx
  • dumping syndrome dx and tx
  • afferent loop syndrome
A
  • alkaline reflux gastritis - HIDA, PPI, cholestyramine, reglan –> RNY
  • dumping syndrome - symptoms (hyperosmotic phase=hypoTN, diarrhea, dizziness. reactive phase=high insulin, low glucose), low carb and frequent meals
  • afferent loop syndrome - CT, RNY
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18
Q

Forrest Classification, risk of rebleeding

A 
Ia - spurting hemorrhage (90%)
Ib - oozing hemorrhage wo visible vessel (10-20%)
II - nonbleeding visible vessel (50%)
IIb - adherent clot (25%)
IIc - flat pigmented spot ( 10%)
III - clean ulcer base (5%)
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19
Q

Obesity surgery for who?

A

BMI >35 +comorbidity (DM, HTN, OSA, HLD)

BMI >40

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20
Q

Roux limb length
Y limb length
pouch volume

A

roux - 130cm
y - 40cm from LOT
pouch - 30-40cc

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21
Q

complications of Roux en y?

A

b12 deficiency - no IF,
iron deficiency anemia - duodenum absorbs iron
gallstones - rapid weight loss

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22
Q

slipped band in gastric band

A
  • UGI = O sign –> remove

dilated pouch, erosion

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23
Q

hypoproteinemic, hypertrophic gastritis

A

Menetrier’s Disease - parietal cell loss, large gastric folds, CMV + h.pylori in children, premalignant

  • dx: chromium labeled albumin test reveal inc GI protein loss
  • tx: antichlorhydric drugs or total gastrostomy
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24
Q

trichobezoar tx

phytobezoar tx

A

trichobezoar - EGD, may need gastrostomy

phytobezoar - chemical dissolution, EGD, diet changes

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25
Q

omeprazole MOA

A

blocks H/K atpase

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26
Q

Metoclopramide MOA, AE
Doperidone MOA, AE
Erythromycin MOA, AE

A

metoclopramide - d2 agonist, 5HT3 antagonist, 5TT4 agonist. AE: inc prolactin, dystonia tardive, AV block, SVT, bradycardia
doperidone - d2 agonist. AE: inc prolactin, QT prolongation
erythromycin - motilin agonist. AE: cholestatic hepatitis, hypersensitivity reaction

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27
Q

vessels ligated during bleeding duodenal ulcer

A

GDA and transverse pancreatic branch

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28
Q

most common sequela of vagotomy

A

diarrhea

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29
Q 
proto-oncogene associations
c-myc: 
c-kit: 
N-myc 
k-ras 
CD117
A 
c-myc: Burkitt's lymphoma
c-kit: GIST (tyrosine kinase)
N-myc - neuroblastoma
k-ras - colorectal cancer
CD117: GIST
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30
Q

Tumor suppressor genes:

  • APC:
  • BRCA-2:
  • DCC -
  • p16 -
  • p53 -
  • VHL -
  • WT-1 -
  • MSH2, MLH1 -
A
  • APC: FAP
  • BRCA-2: breast cancer (men and women), pancreatic cancer, ovarian cancer, prostate cancer
  • DCC - colorectal cancer
  • p16 - familial melanoma, pancreatic cancer (DCKN2A)
  • p53 - Li-Farumeni
  • VHL - kindey cancer, reitinal cancer, brain cancer
  • WT-1 - Wilm’s tumor
  • MSH2, MLH1 - DNA mismatch repair, Lynch syndrome
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31
Q

cell type: recognize cells lacking self MHC1, triggers APC death apoptosis

A

NK cells

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32
Q

cell type: recognize (D) PAMPs

A

TLR

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33
Q

cell type: opsonizes foreign antigens

A

complement cascade

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34
Q 
IL-1
IL-2
IL-4
IL-6
TNFa
Interferons
A 
IL-1 - fevere
IL-2 - matures T cells
IL-4 - IgE, matures B cells into plasma cells
IL-6 - fever and acute phase reactants
TNFa - septic shock
Interferons - secreted by NK cells
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35
Q

cell type: release, IL-2, IL-4, IFN-G. involved in type IV hypersensitivity

A

helper T cells (CD4

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36
Q

cell type: CD8 , regulate CD4, CD8

A

suppressor T cells

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37
Q

cell type: CD8, recognize and attack non-self antigens attached to MHC

A

cytotoxic T cells

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38
Q

cell type: IL-4 stimulates this, 10% become memory

A

B cells

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39
Q

MHC

  1. which chromosome?
  2. expressed by all nucleated cells?
  3. HLA type for MHC I?
  4. expressed on thymic epithelium and APC
  5. HLA type for MHC II?
A
  1. chromosome 6
  2. MHC I
  3. A, B, C
  4. MHC II
  5. DP, DQ, DR* most important
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40
Q

cell type: highly phagocytic APC, expresses MHC II

A

dendritic

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41
Q

Hypersensitivity Reaction: Anaphylaxis, Atopic, Allergic

A

I

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42
Q

Hypersensitivity Reaction: IgE mediated, release of histamine

A

I

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43
Q

Hypersensitivity Reaction: antibody mediated

A

II

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44
Q

Hypersensitivity Reaction: Rh incompatibility

A

II

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45
Q

Hypersensitivity Reaction: myasthenia gravis, hyperacute reaction

A

II

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46
Q

Hypersensitivity Reaction: cytotoxic

A

II

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47
Q

Hypersensitivity Reaction: rheumatoid arthritis, lupus, serum sickness

A

III

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48
Q

Hypersensitivity Reaction: immune complex deposition

A

III

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49
Q

Hypersensitivity Reaction: delayed

A

IV

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50
Q

Hypersensitivity Reaction: antigen stimulated by prior sensitized T cells

A

IV

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51
Q

Hypersensitivity Reaction: transplant rejection

A

IV

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52
Q

transfusion reaction: fevers, chills, DIC due to a release of cytokines from donor

A

acute hemolytic reaction

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53
Q

transfusion reaction: respiratory distress

A

TRALI

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54
Q

transfusion reaction: circulatory overload

A

TACO

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55
Q

Transplant induction medications

A

thymoglobulin, basilizimab, alemutuxumab

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56
Q

drug: rabbit immunized with human thymocytes. T cells bound by antibody, osponized

A

Thymoglobulin

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57
Q

drug: anti-IL-2 receptor

A

Basiliximab

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58
Q

drug: recombinant IgG1 monocolona, CD52 (on T and B lymphocytes)

A

Alemtuzumab

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59
Q

Anti-metabolite drugs

A

MMF, Azathioprine

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60
Q

drug: inhibits purine (guanine) synthesis by inhibiting IMPDH

A

MMF

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61
Q

MMF AE

A

GI symptoms, myelosuppression

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62
Q

drug: metabolized to 6-MP (purine antagonist) incorporated into DNA and blocks replication, RNA transcription

A

Azathioprine

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63
Q

Azathioprine AE

A

malignancy, hepatitis, myelosuppressio, pancreatitis, alopecia. reserved for patients intolerant of MMF

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64
Q

Calcineurin inhibitors

A

cyclosporine, tacrolimus

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65
Q

drug: binds to cyclophilin-A, inhibits calcineurin, downregulates IL-2 expression

A

cyclosporin

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66
Q

immunosuppression drug secreted in bile

A

cyclosporine

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67
Q

drug: binds FKBP, complex inhibits calcineurin, IL-2, IL-3, IL-4, IFN-G

A

tacrolimus

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68
Q

tacrolimus AE

A

nephrotoxicity, HTN, hyper K, hypoMg, tremors/seizures, AMS

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69
Q

mTOR inhibitors

A

sirolimus, everolimus

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70
Q

drug: binds FKBP, and inhibits mTOR

A

sirolimus or everolimus

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71
Q

sirolimus AE

A

less nephrotoxic than tacrolimus, pneumonitis, wound healing effects

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72
Q

glucocorticoid MOA

A

inhibits COX2 and decreases prostaglandin synthesis, inhibits NFkB

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73
Q

how do hyperacute rejections occur?

A

preformed antibodies (type II hypersensitivity)

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74
Q

how to prevent hyperacute rejection?

A

test PRA assay - serum IgG and IgM to HLA haplotypes

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75
Q

what is cross matching:

A

serum IgG.igM antibodies for binding to donor lymphocytes. mixes serum of recipent with donor lymphocytes

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76
Q

what is acute cellular rejection? how do you treat it?

A

cytotoxic and helper T cells agains donor HLA

- immunosuppression, pulse steroids

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77
Q

what is chronic rejection? how do you treat?

A

partially type IV hypersensitivity + antibody formation

- retransplant

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78
Q

MCC of chronic rejection?

A

HLA incompatibility

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79
Q

PRA panel to not transplant?

A

> 50%

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80
Q

owl eyes after transplant? treatment?

A

CMV, gancyclovier

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81
Q

Virus to cause ureteral obstruction or fibrosis after kidney transplant? tx?

A

BK virus. decrease immunosuppression

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82
Q

virus that causes B cell proliferation and SBO

A

EBV

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83
Q

makes up MELD

A

Cr, INR, bilirubin

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84
Q

Milan criteria

A

singe lesion <5cm, 3 lesions < 3cm, no macrovascular invision or mets

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85
Q

anesthesia drug: hepatitis, eosinophilia

A

Halothane

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86
Q

anesthesia drug: low mac

A

halothane

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87
Q

anesthesia drug: fast onset, less laryngospasm

A

sevoflurane

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88
Q

anesthesia drug: used in neurosurgery

A

isoflurane

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89
Q

anesthesia drug: least myocardial depressino, high MAC

A

nitrous oxide

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90
Q

what does it mean to be a high MAC?

A

less lipid soluble, fast onset, less potent

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91
Q

anesthesia drug: AE: bradycardia, hypoTN, hypertriglyceridmia, rhabdomyolysis

A

propofol

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92
Q

anesthesia drug: gaba agonist

A

propofol

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93
Q

anesthesia drug: can cause adrenocorticosuppression

A

etomidate

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94
Q

anesthesia drug: induction that is fast acting and has the least changes in hemodynamics

A

etomidate

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95
Q

anesthesia drug: inc secretions and cardiopulmonary demand. Dosage in the ED for procedures?

A

ketamine - .5-1mg/kg

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96
Q

anesthesia drug: depolarizing agent

A

succinylcholine

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97
Q

anesthesia drug: hoffman elimination

A

cisatracurium, slow onset

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98
Q

rapid anesthesia reversal

A

sugammadex

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99
Q

lidocaine toxicity

A

wo epi - 5mg/kg

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100
Q

bupivicaine toxicity

A

2mg/kg

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101
Q

ASA classification

A

I - nomral
II - pregnancy, smoker, social ETOH, BMI <40, DM controlled
III - ESRD, BMI >40, hepatitis, premature infant, old CVA or MI
IV- new ESRD, spepsi, ARD, CHFrEF, new CVA or MI
V- patient not expecting to survive
VI - dead

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102
Q

MC congenital heart defect

A

VSD

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103
Q

Tetralogy of Fallot? which shunt?

A

pulmonary stenosis, RVH, overriding aorta, VSD (boot shaped heart). R to L shunt

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104
Q

what med to give for cyanotic children to keep the PDA open for lung oxygenation?

A

PGE-1 (prostaglandin)

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105
Q

which nerve runs anterior to the pulmonary hilum? posterior?

A

anterior - phrenic, posterior- vagus

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106
Q

which type of pneumocyte helps with gas exchange? surfactant?

A

I

II

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107
Q

thoracic lymph node stations?

A 
1-9 = mediastinal
10-11 = hilar
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108
Q

Thoracic outlet anatomy (start with clavicle)

A

clavicle –> subclavian vein –> phrenic nerve –> anterior scalene –> subclavian artery –> brachial plexus –> middle scalene

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109
Q

Lung volume and capacity: what makes of the:

  • FRC?
  • vital capicity
A
  • expiratory reserve volume and residual volume

- inspiratory, TV, expiratory

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Perfectly
110
Q

how does the FRC increase in aging?

A

inc residual volume

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111
Q

need post op FEV1 to be what to do well postoperatively?

A

FEV1 >0.8 or >40%

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112
Q

causes of decreased DCLO

A

lowered capillary surface area, low Hgb, increased dead space, pulmonary HTN, low CO

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113
Q

no lung resection if:

A
  • pCO2>50 or O2<60
  • VO2 max <15
  • DCLO <60%
  • FEV1 < 2L for pneumonectomy, <1.5 for lobectomy, or <0.8 for wedge resection
  • VQ scan < 40%
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114
Q

lung cancer staging: mediastinoscopy/EBUS for what?

A

centrally located tumor, LN stations 1-4, 7, 10-12

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115
Q

lung cancer staging: chamberlain procedure for which LN?

116
Q

lung cancer treatment:

  • < 5cm
  • > 5 and resectable
  • not resectable
A
  • < 5cm –> VATS
  • > 5 and resectable –> neoadjuvant chemo + resect
  • not resectable –> definitive chemotherapy
117
Q

popcorn lesion in the lung

A

harmartoma

118
Q

small cell lung cancer

- tx?

A 
neuroendocrine tumor (+kulchitsky cells)
- chemoXRT
119
Q

what does small cell lung cancers release?

A

inc ACTH, inc ADH –> cushing disease

120
Q

what does SCC of the lung release?

121
Q

is a pancoast tumor usually small cell or nonsmall cell?

A

non small cell

122
Q

is SVC syndrome usually small cell or non small cell?

A

small cell

123
Q

Lights criteria

A

LDH >0.6
protein >0.5
pleural LDH > 2/3

124
Q

if need to feeds chylothorax, which FA can they have?

A

medium chain. LCFA are directly absorbed

125
Q

anterior mediastinal tumor

A

thymoma (and other terrible Ts)

126
Q

MC mediastinal tumor

A

neurogenic tumor

127
Q

subclavian v thrombosis?

A

thrombolytics or thrombectomy if acute

128
Q

tuboovarian abscess cut off for surgery?

A

<7cm will resorb - only need antibiotics

129
Q

Meig’s syndrome

A

ovarian fibroma –> ascites and hyrothorax (inc VEGF)

130
Q

which serum markers for testicular cancers? what for prognosis?

A
  • AFP, b HCG

- LDH

131
Q

do you bx testicular cancer?

132
Q

seminoma tx

A

XRT (radiosensitive). chemo reserved for metastatic disease

133
Q

elevated AFP in testicular cancer?

A

non-seminomatous

134
Q

nonseminomatous testicular cancer tx:

A

orchiectomy and LN dissection, >stage II get chemotherapy (BEP)

135
Q

L varicocele

A

RCC on the left

136
Q

femur fx tx

- children

A

ORIF - careful of fat embolism

- reduction only

137
Q

posterior knee injury

A

popliteal artery injury

138
Q

shoulder dislocation

A

most anterior –> axillary nerve injruy

139
Q

midshaft humerus fx

A

radial nerve injury (wrist drop)

140
Q

Volkmann contracture

A

supracondylar humerus fx : anterior interosseus artery or brachial artery

141
Q

ewing sarcoma

- tx

A

onion skinning, pseurorosettes

- chemo THEN xrt and surgery

142
Q

osteogenic sarcoma

- tx

A

sunburst pattern, codman triangle

- doxyrubicin chemo

143
Q

hyperparathyroidism mutation

A

PRAD oncogene

144
Q

pubic symphysis sensation

A

iliohypograstric

145
Q

tPA reversal

A

aminocaproic acid

146
Q

brown recluse bite tx

147
Q

echinococcus tx

A

albendazole

148
Q

cranial nerve injured in temporal bone fx

149
Q

cushing triad

A

kussmal respirations, HTN, bradycardia

150
Q

source of histamine in the blood

151
Q

antibiotic after a human bite and allergic to PCN

A

doxycycline

152
Q

Sipple syndrome

153
Q

hereditary pancreatitis

A

PRSS1, PRSS2, CFTR, SPINK1

154
Q

most common nerve injured in parotidectomy

A

greater auricular

155
Q

upper lip cancer

A

basal cell

156
Q

radical neck dissection includes what?

A

spnal accessory nerve, SCM, IJ

157
Q

pharyngeal cancer tx

158
Q

nasopharyngeal CA associated with?

159
Q

salivary gland cancer –> large salivary gland

160
Q

dx for salivary gland CA

A

superficial parotidectomy

161
Q

MC malignant salivary gland tumor

A

mucoepidermoid

162
Q

second MC malignant salivary gland tumor

A

adenoid cystic tumor

163
Q

tx for salivary gland tumor

A

total parotidectomy, MRND and post op XRT

164
Q

MC benign salivary gland tumor. Second MC?

A

pleomorphic adneoma. warthins tumor

165
Q

sensation:

  • great auricular nerve (C2-3)
  • lesser occipital nerve (C2)
  • auriculotemporal nerve (CN V3)
A
  • great auricular nerve (C2-3) - lower ear, skin over parotid
  • lesser occipital nerve (C2) - upper posterior ear
  • auriculotemporal nerve (CN V3) - anterior upper ear –> Freys
166
Q

when to perform esophagectomy?

167
Q

when to perform esophagectomy + chemoXRT

A

T2 (muscularis propria)

168
Q

Stewart classification. how to tx?

A

I - 1-5cm above GE junction (tx like esophageal ca)
II - 1cm above to 2cm below the GE junction (tx like esophageal ca)
III - 2-5 cm below the GE junction (tx like gastric cancer)

169
Q

chemo regimen for esophagus

A

paclitaxel, carboplatin, or flurouriacil and oxiplatin

170
Q

primary blood supple to stomach after resection for esophagectomy?

A

R gastroepiploic

171
Q

margins for gastric cancer?

172
Q

signet ring cells –> tx?

A

total gastrectomy

173
Q

gastric cancer tx?

A
  • T1b surgery

- >T2 tx like esophageal cancer –> ECF (3 and 3) or FLOT (4 and 4)

174
Q

how many LN for gastric cancer?

175
Q

mutations in gastric cancer for young people?

A

CDH1 and e-cadherin (also inc lobular carinoma of the breast)

176
Q

tx for hereditary diffuse gastric cancer?

A

prophylactic gastrectomy between 18-40yrs

177
Q

most common gastric lymphoma?

A

B cell (nonhodkins)

178
Q

tx of gastric lymphoma?

A

chemo XRT –> risk of perforation

179
Q

GIST tumor cells

A

interstitial cells of Cajal

180
Q

spindle cells

A

GIST tumor

181
Q

LND for GIST? margins for GIST?

A

no - mets to liver, negative microscopic margins

182
Q

GIST tx:

A

imatinib and surgery

183
Q 
Pancreatic cells
Alpha cells 
Beta cells (at center of islets)
Delta cells 
PP or F cells 
Islet cells
A

Alpha cells – glucagon
Beta cells (at center of islets) – insulin
Delta cells – somatostatin
PP or F cells – pancreatic polypeptide
Islet cells – also produce vasoactive intestinal peptide (VIP), serotonin

184
Q

when to give chemotherapy to whipple patient?

A

pre and post surgery

185
Q

when to give chemotherapy to whipple patient?

A

pre and post surgery

186
Q

colonoscopy screening recommendations

  • first degree relative with CA or adenoma <60yr or 2 first degree relatives with CA at any age
  • first degree after 60 or 2 second degree at any age
A
  • average risk 45 q10 yrs
  • first degree relative with CA or adenoma <60yr or 2 first degree relatives with CA at any age –> 40 q 5 yrs
  • first degree after 60 or 2 second degree at any age –> 40 q 10 yrs
187
Q

polyp screening recommendations

  • FAP
  • HNPCC
  • personal hx of 1-2 small andeomas
  • 3+ adenomas
  • advanced adenomas (>1cm, high grade, dysplasia, villous elements)
A
  • FAP: 10-12yrs q 1 yr
  • HNPCC: 20-25 (or 10 years prior) q 1-2 yrs
  • personal hx of 1-2 small andeomas - 5 yrs
  • 3+ adenomas - 3 yrs
  • advanced adenomas (>1cm, high grade, dysplasia, villous elements) - 1-3 years
188
Q

HNPCC inheritance

A

autosomal dominant

189
Q

HNPCC defect

A

DNA mismatch repair (dMMR)

190
Q

rectal cancer tx:

A

TIII+ (muscularis propria) - chemoXRT (capecitabine or 5-FU + 5000 cGy)

191
Q

Anal cancer HPV

192
Q

MC soft tissue sarcoma

A

undifferentiated pleomorphic sarcoma

193
Q

MC soft tissue sarcoma of the extermity

A

malignant fibrous histiosarcoma

194
Q

soft tissue sarcomas spread LN vs hemoatgenous?

A

hemotogenous

195
Q

which soft tissue sarcomas spread via LN?

A

rhambdomyosarcoma, epitheliod, clear cell, synovial, angiosarcoma

196
Q

stewart treves syndroem

A

lymphangiosarcoma

197
Q

inc risk for sarcomas

A
  • irradiation, phenoxyacetic acid, chlorophenols
198
Q

thorium oxide, vinyl chloride, arsenic exposure?

A

hepatic angiosarcoma

199
Q

most important prognostic factor for retroperitoneal sarcomas?

A

resectibility

200
Q

MC soft tissue sarcoma in kids? worst prognosis subtype?

A

rhabdomyosarcoma. alveolar

201
Q

rhabdomyosarcoma tx?

A

VAC neoadjuvant –> surgery –> RT for positive margins

202
Q

how to tx kaposi sarcoma?

A

HAART, XRT for local disease, interferon alpha for disseminated disease. surgery for intestinal hemorrhage

203
Q

Soft tissue sarcoma: CNS tumors, peripheral sheath tumor, pheochromocytoma

A

Neuofibromatosis

204
Q

Soft tissue sarcoma: sarcoma, bone, brain, breasst, leukoema, lung, adrenal cancer

A

LI-Fraumeni (p53)

205
Q

Soft tissue sarcoma: FAP, desmoid tumors

206
Q

best chemotherapy for soft tissue sarcoma

A

doxyrubicin

207
Q

histology stains for melanoma

A

S100, HMB-45, tyrosine

208
Q

Melanoma staging

A 
T1- <1mm
T2 - 1-2mm
T3 = 2-4mm
T4 - >4mm
stage IIC T4, N0
stage III = +N
209
Q

immunotherapy for melanoma

A

ipilimumab (CTL4 inhibitor) - upregulate CD4, blocks T cell upregulation
Nivolumab) - (PD1 inhbitor) - upregulatd CD4
MEK/BRAF inhibitors - MAP kinase pathway (V600 protein kinase)

210
Q

boundaries of the femoral triangle for lymphadenectomy

A

superior - inguinal ligament
lateral - sartorius
medial - adductor longus
* start at the ASIS and come down

211
Q

tumor markers:

  • AFP
  • CA125
  • Beta HCG
  • Chromogranin A
  • Ret oncogene
  • NSE
A
  • AFP: liver CA
  • CA125: ovarian cancer
  • Beta HCG: testicular cancer, choriocarcinoma
  • Chromogranin A: carcinoid (HIAA seritonin)
  • Ret oncogene: medullary thyroid
  • NSE: small cell cancer, neuroblastoma
212
Q 
chemoman:
cisplatin
carboplatin
oxaloplatin
vincristine
vinblastine
cyclophosphamide
taxol
A

cisplatin: nephrotoxic, neurotoxic, ototoxic
carboplatin: mylosuppression
oxaloplatin: same as cisplatin
vincristine: peripheral neuropathy
vinblastine: mylosuppresion
cyclophosphamide; SIADH, hemorrhagic cystitis
taxol: neuropathy

213
Q

dx for SBP
- PMNs:
tx?

A

PNMs >250

tx: 3rd gen cephalosporin

214
Q

Antibiotic MOA

  • vancomycin, bacitracin
  • clindamycin, linezolid, macrolide
  • aminoglycosides, tetracycline
A
  • vancomycin, bacitracin: blocks cell wall synthesis
  • clindamycin, linezolid, macrolide: 50S subunite
  • aminoglycosides(bacteriocidal - irreversible binding), tetracycline(bacteriostatic): inhibits 30S subunit
215
Q

how does aminoglycoside resistance work?

A

decreased active transport

216
Q

AE: zosyn

A

platelet dysfunction, high salt load

217
Q

AE: ceftriaxone

A

cholestasis

218
Q

AE: carbapenem

219
Q

Antibiotic MOA

  • Rifampin
  • Sulfonamides:
  • Trimethoprim:
  • daptomycin, polymyxin
A
  • Rifampin: mRNA polymerase inhibitor
  • Sulfonamides: PABA analogue, inhibits purine synthesis
  • trimethoprim: block folic acid synthesis and purine synthesis
  • daptomycin, polymyxin: membrane integrity
220
Q

Bactrim AE:

A

SJS and nephrotoxicity

221
Q

lateral pectoral nerve innervates?

A

pectoralis major

222
Q

BIRADs

A 
0 - need additional imaging
I - negative
II- benign
III - probably benign - rpt 6 mo
IV - suspicious - tissue diagnosis
V - highly suspicious - tissue diagnosis
VI - known biopsy proven malignancy
223
Q

hemorrhagic shock

  • HR>100
  • decreased BP
  • dec UOP
  • anxious
  • HR>140
  • negligible UOP
  • confused
A
  • HR>100: II
  • decreased BP: III
  • dec UOP: III
  • anxious: III
  • HR>140: IV
  • negligible UOP: IV
  • confused: IV
224
Q

CPP

  • goal CPP
  • normal ICP
A

CPP=MAP-ICP

  • goal CPP >60
  • normal ICP = 10
225
Q

AA to embolize in a posterior nose bleed

A

internal maxillary artery

226
Q

best exposure for L carotid injury

A

L anterolateral thoracotomy, median sternotomy (Cristiano care)

227
Q

Blunt cerebrovascular injury grading

A 
25-POT
I- <25
II ->25
III - pseudoaneursym
IV - vessel occlusion
V - vessel transection
228
Q

which side for thoracostomy?

  • trachea
  • proximal L mainstem
  • distal L mainstem
A
  • trachea - R
  • proximal L - R
  • distal L - R
229
Q

best exposure for:

  • innominant A
  • proximal R subclavian A
  • proximal R common carotid A
A

all: median sternotomy

230
Q

best exposure for:

aortic transection

A

L thoracotomy

231
Q

pancreatic trauma tx:

  • L of SMV:
  • R of SMV:
A
  • L of SMV: distal panc

- R of SMV - closed suction

232
Q

nonop splenic injuries

A

<50% destruction, 1-3cm lac

233
Q

delta pressure less than ___ is indicative of compartment syndrome
- compartment pressure > ____ is indicative of compartment syndrome

234
Q

hand flexors

  • PIP
  • DIP
A
  • PIP: flexor digitorum superficialis

- DIP - profundus

235
Q

MC infection in burn

A

psuedomonas

236
Q

contracture (primary or secondary)

  • FTSG
  • STSG
A
  • FTSG= primary contracture

- STSG = secondary contracture

237
Q

silvadene AE

A

neutropenia, agranulocytosis

238
Q

silver nitrate AE

A

hypo Na/Cl/K/Ca, methemaglobinemia

239
Q

sulfamylon (mafenide sodium) AE

A

metabolic acidosis

240
Q

hypthermia

A

mild = <35
modereate = 28-32
severe =20-28
profound < 20

241
Q

how to measure fetal maturity?

A

lecithin:sphingomyelin ratio >2:1, phosphatidylcholine in the amniotic fluid

242
Q

SMA exposure

A

L visceral rotation or pull colon caudad

243
Q

SNL for phyllodes?

A

no - hematogenous spread. do not need axillary staging

244
Q

breast ca: clear cytoplasm and large nucleus

A

pagets disease

245
Q

how to manage pleomorphic LCIS?

A

mangae like DCIA

246
Q

how to tx inflammatory breast ca

A

neoadjuvant chemotherapy, MRM, XRT

247
Q

breast cancer staging

A 
T1: < 2cm
t2: 2-5
T3 >5
T4: invasion
N1: 1-3 notes
N3; >10 nodes
Stage II = T2N1, T3N0
stage III = T3N1, T4N0
248
Q

when to consider neoadjuvant chemo?

A

> 5cm tumor

249
Q

BRCA1 - chromosome, gene type

A

17, suppressor gene

250
Q

BRCA2 - chromosome, gene type

A

13, suppressor gene, DNA repair

251
Q

neck LN V

A

posterior neck - spinal accessory nerve injury

252
Q

antibody development when have HIT

A

platelet factor 4

253
Q

ileal brake during fatty foods

A

peptide YY

254
Q

first branch off the ICA

A

opthalmaic A

255
Q

MC nerve iinjured in CEA

256
Q

debakey classifications

A

I - both
II - ascending
III descending

257
Q

indications for AAA

A

sypmtomatic, >5.5 or 5.0 in marfans, rapidly increasing >0.5 per year
- repair open if >6.5 cm

258
Q 
criteria for endovascular repair
- neck length
- neck diameter
- neck angulation
- common iliac artery length
common iliac artery diameter
otehr
A
  • neck length - 15
  • neck diameter - <30
  • neck angulation <60
  • common iliac artery length >10
  • common iliac artery diameter 8-18
    otehr
259
Q

Endoleaks

A 
I above and belo
II - retrograde flow from lumbars
III - defect in graft
IV wall porostoy 
V - inc in aneursym
* repair I and III
260
Q

renin in Conn’s syndrome (hyperaldosteronemia)

261
Q

how to diagnose hyperaldosteronism

A

salt load suppressio tesdt: urine aldosterone will remain high, aldosterone:renin ratio >20

262
Q

localizing studies for hyperaldosteronism

A

NP-59 scintigraphy, CT scan

263
Q

metabolic change in hyperaldosteronism

A

hypernatremia, hypokalemia, alkalosis

264
Q

how to test for hypocortisolism

A

cosyntropin test

265
Q

adrenal hyperplasia tx:

A

metyrapone and aminogluthemide

266
Q

antithyroid antibodies/thyroglobulin antibodies

A

hashimotos

267
Q

TSH receptor antibodies

268
Q

bestheda

A 
I nondiagnostic
II benign
III FNA
IV lobectomy
V thyroidectomy
VI malignant
269
Q

sulfur colloid scan in hepatic adenoma

A

will not see kupffer cels

270
Q

central stellate scar in the liver. kupffer cells?

A

FNH - yes kupffer cells

271
Q

varient for HCC in kids

A

fibrollamellar variant

272
Q

tx: of HCC

drug in HCC

A

depends - surgery (1cm margins), ablation, arterial directed theray, radiation, transplant
sorafenib

273
Q

dermatitis, Dm, depression, DVT

A

glucagonoma

274
Q

watery diarrhea, hypokalemia, achlorhydria

275
Q

TEG

prolonged K

A

clot strength - cyro (“kryo”)

276
Q

TEG

R time

A

“reaction time” for clotting factors - FFP

277
Q

TEG

angle

278
Q

TEG

- MA

A

maximum amplitude - platelets

279
Q

TEG

- ly

A

lysis time - TXA

280
Q

most common extracranial solid tumor in peds

A

neuroblastoma

281
Q

peds:

increased catecholamines, VMA, HVA

A

neuroblastoma

282
Q

neuroblastoma tx

A

doxyrubicin

283
Q

best prognosis in hepatoblastoma

A

pure fetal histology

284
Q

hepatoblastoma tx

A

doxyrubicin and resection

285
Q

MC TE fistula

A

C - air in the stomach

286
Q

gasless stomach

A

A (blind ending) and B

random (1 decks)

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