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1
Q

B calcaneal frx a/w what other injury?

A

Lumbar compression frx

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2
Q

Best predictor for extubation? How calculated?

A

RSBI, RR/Tv, >105 is highly predictive

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3
Q

When should warfarin be held for elective cases?

A

Nonvalve afib with chads2vasc<5 for 5 days prior

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4
Q

Bedrest and activity restrictions for ped splenic injuries?

A

Lift bedrest when HDS, activity grade + 2 weeks

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5
Q

Pt develops pancreatic pseudocyst and PVT, next step?

A

Egd to look for varices

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6
Q

CT characteristics of hepatic adenoma? Risks?

A

CT: heterogenous mass w rapid enhancement during arterial phase
Risks: bleed»malignant transformation

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7
Q

Hepatic hemangioma CT characteristics?

A

Low density and peripheral nodular enhancement over time

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8
Q

RAAS overview?

A

Liver makes angiotensinogen, renin from kidney cleaves to At1, ACE from lungs cleaves to At2, which acts on kidneys, adrenals, vessels, pituitary

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9
Q

Septic vs neurogenic shock (CI, SVR, CVP)

A

Septic: CI up, SVR and CVP down
Neurogenic: all down

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10
Q

How to determine study design?

A

Was exposure assigned? Tells you controlled or not (random?)
What was the study direction? If exposure then outcome it’s cohort, if exposure before outcome it’s case control, if at same time is cross sectional

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11
Q

Best intervention for biliary complication (bike leak)

A

ERCP (dx and tx)

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12
Q

What circumstances should PD cath be removed?

A

Refractory peritonitis (doesn’t respond to abx, relapsing, repeat episode in 4 weeks)

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13
Q

Lynch syndrome AKA? Mutation?

A

HNPCC; MSH6 (mismatch repair gene)

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14
Q

FAP gene? PJS? Juvenile polyposis? Cowden? Lynch?

A

FAP: APC
PJS: STK11
JPS: SMAD4
Cowden: PTEN
Lynch: MLH/MSH/PMS

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15
Q

Adenoid cystic carcinoma features

A

Spreads along nerves, common lung mets after dormant period

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16
Q

Cerebral salt wasting vs SIADH

A

CWS signs of dehydration vs SIADH signs of hypervolemia (both have hypoNa, hyperOsm urine)

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17
Q

RYGB shown to improve what conditions in best to worst order?

A

DM>HTN>HLD

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18
Q

3 types of vagotomy and associated nerves?

A

Truncal: main trunk of both vagus ligated

Selective: ant and post nerves of Latarjet ligated resulting in pyloric denervation so need pyloric drainage

Highly selective: parietal vagotomy, ligate nerves to parietal cells in stomach serosa (fundus and body), does not denervate pylorus

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19
Q

Most important negative prognostic factors for thyroid ca

A

Distant mets>age over 55, local extension, size over 4cm, Male

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20
Q

What are the BCAA?

A

Leucine, isoleucine, valine (LIV)

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21
Q

Anaphylaxis after blood transfusion?

A

Likely IgA deficiency due to host anti-IgA abs vs transfused IgA abs

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22
Q

Electrolyte rearrangements with TLS?

A

HypoCa, hyperuremia, hyperK, hyperphos

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23
Q

Horseshoe abscess incision?

A

Posterior midline to drain deep post anal space and B incisions to drain ischiorectal fossae

24
Q

Preferred vte ppx?

A

LMWH
Use UFH if renal insufficiency

25
Q

What’s the main reason for interval appendectomy after perf appendicitis? Risk of recurrent appendicitis if treated w abx alone/drainage?

A

Neoplasm
Recurrence rate 5-38%

26
Q

What do lateral and medial pec nerves innervate?

A

Lateral: pec major
Medial: pec major and minor

27
Q

What does long thoracic innervate?

A

Serratus anterior; lose abduction, winged scapula

28
Q

Gene and lesions associated with MEN1, 2A, 2B

A

1: MEN1; pituitary, parathyroid hyperplasia, pancreas
2A: RET; parathyroid, medullary thyroid ca, adrenal pheo
2B: RET; medullary thyroid ca, adrenal pheo, GI, marfanoid habitus

29
Q

Spontaneous skin ulceration years after chronic lymphedema?

A

Lymphangiosarcoma; need incis bx/WLE

30
Q

Chyle leak management

A

First line is low fat diet with med chain TG, can add octreotide to dec output, npo + tpn if diet fails, embol w lymphangiography, surgical ligation

31
Q

What defines postop panc leak?

A

Drain with amylase>3x serum amylase on pod3

32
Q

What are carotid body tumors? How to resect?

A

Paraganglioma at carotid bifur. Try to excise. Rtx if encase carotids

33
Q

What index serves best for geriatrics undergoing emergency surgery to predict postop outcomes?

A

Frailty index

34
Q

Adverse effects of mafenide acetate? Silver sulfadiazine? Silver nitrate?

A

MA: metabolic acidosis
SS: neutropenia, tcp
SN: methemoglobinemia

35
Q

MC anterior mediastinal mass? Posterior?

A

Anterior: lymphoma
Posterior: neurogenic (present w mass effect or horners)

36
Q

When is resection of HCC contraindicated?

A

Cirrhosis, PVH
Need txp

37
Q

What is glucagon dose?

A

1mg, relaxes oddi

38
Q

What are the lung fissures?

A

Left: major/oblique
Right (3 lobes): minor/horizontal separates upper from middle and major separates middle from lower

39
Q

MC vitamin def in bariatric patients? Sx?

A

Vitamin D: fatigue, weak, dec bone density

40
Q

How does dobutamine work?

A

Beta-1 agonist in heart to inc contractility, at higher doses exerts beta-2 effect to vasodilate

41
Q

Tx order for MEN1?

A

Hyperparathyroid first w four gland resection and autoimplant
First sx is hyperCa

42
Q

Which type of lung ca causes hypoNa? How? Which causes hyperCa?

A

Small cell: SIADH
Squamous cell causes hyperCa via rPTH peptide

43
Q

Surgical tx for massive lower GIB w unclear source?

44
Q

What can cause EPO to fail? Need to check prior to starting

A

Iron deficiency, check Fe studies

45
Q

How is a pyloromyotomoy done?

A

Longitudinal incision along anterior pylorus extending to nonhypertrophied pylorus, separate muscle fibers, watch for gastric mucosa bulging out to signify completeness

46
Q

Loss of pitch phonation after thyroidectomy?

A

Injury to external branch of SLN unnerving crycothyroid (internal branch is purely sensory)

47
Q

Fevers, chills, mesenteric mass in post txp patient?

48
Q

When do you not repair ventral hernias electively?

A

BMI>50, smokers, a1c>8

49
Q

Fluoroquinolones and moa?

A

Cipro/levoflox; inhibit DNA gyrase

50
Q

Sx of hypermag? Tx?

A

Paralysis, hypotension, confusion
Calcium first then hydrate and diurese

51
Q

What would favor earlier elective intervention for sigmoidectomy for divertic?

A

Immunosuppression (txp pt, alcoholics, chemo pt)

52
Q

What’s a non recurrent laryngeal nerve? Associated with?

A

Aberrant course, inc risk of injury; on the R a/w arteria lusoria or aberrant R SCA; on L a/w right side aortic arch

53
Q

Absolute CI to BCT?

A

First trimester, inflammatory breast ca, inability to achieve clear margins, diffuse microcalcs

54
Q

Tx for anal squam cell carcinoma?

A

Chemortx; APR if still bad; maybe WLE if away from sphincter and get 1cm margins

55
Q

Insulinoma sx and tx?

A

Fasting hypoglycemia, sx resolve w glucose admin, high serum c-peptide
Enucleate if <2cm, resect if >2

56
Q

Phases of GVHD

A
  1. Recipient conditioning: damage to recipient tissue
  2. Donor T cells differentiate into th1 and th17 lineages
  3. Tissue dysregulation

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