random Flashcards
indomethicin
prevents preterm labor, close PDA, treat gout
steady state reached at how many half lives
5
cyp-450 inhibitors
isoniazid, ketoconazole, erythromycin, fluoroquin, flagyl, allopurinol, verapamil, amiodarone, MAOIs, disulfiram
best test for colovesicular fistula
CT scan
SE mafenide
metabolic acidosis
SE silver nitrate
hypochlor, hyponatremia
SE silvadene
neutropenia, increased risk of kernicterus
GI CMV treatment
ganciclovir
SE tacrolimus
htn
SE sirolimus
poor wound healing
annular pancreas tx
duodenojejunostomy
AVF needs
vein >3mm artery >2mm
most sensitive phase of cell cycle for radiation
M phase
respiratory quotient
CO2 prod/O2 consumed
gold std for bladder injury
CT cystography
appendicitis visceral pain
periumb pain
appendicitis somatic pain
RLQ pain
Pulm sequestration extralobar blood supply
systemic arterial and venous
pulm sequestration intralobar blood supply
aorta, pulm vein
1 presentation of pulm sequestration
infection
copper def
neutropenia, pigment change, arrhythmia
iron def
anemia, glossitis, brittle nails, cardiomeg
Mg def
nausea, weakness, AMS
selenium def
cardiomyopathy, growth retardation, pain, weakness
zinc def
poor wound healing, hair loss, testicular atrophy , diarrhea, dermatitis
best initial test to diagnose esophageal perf
gastrograffin
contrast enhancement during arterial phase with prominent central scar
FNH
sarcoma spreads via
hematogenous usual
spread via lymph nodes
clear cell, angiosarcoma, rhabdomyosarc, synovial, epitheliod
arterial enhancement with portal venous washout
HCC
Milan
3 < 3cm, 1 <5cm
UCSF criteria
1 <6cm, 3 <4.5cm total <8cm
ablation size cutoff
< 2 cm
amebic abscess treatment
flagyl
VHL
CNS hemangioblastoma, pheo, clear cell renal, cystadenoma of pancreas, papillary cystadenoma of epidid/broad ligament
atropine mechanism
competitive inhibitor of acetylcholine muscarinic R
most radiosensitive
seminoma
adenoid cystic carcinoma of salivary gland
slow, insidious onset, late presentation of distant mets, high avidity for nerves
fuel for colonic cells
short chain FA - acetate, butyrate, propionate
tx of undiff spindle cell (malignant fibrous histiocytoma of bone)
neoadj chemo and excision with wide margins
langerhans cells (aka dendritic cells) are derived from
monocytes
langerhans cells require stim by
colony stim factor 1
deep pressure and high freq vibration
pacinian corpuscle
warmth, skin stretch
ruffinis
cold, low freq vib
krause end bulb
light pressure and tactile sense
meissners
thermal regulation and hypotonic sweat
accrine
palms and soles
apocrine sweat (via sympathetic NS and acetylcholine)
predominant collagen type
type I
melanoma markers
S100, HMB-45
systemic treatment for melanoma
dacarbazine for + nodes or mets, stage IIIB or IV
treatment for >4 nodes + melanoma
XRT - also used for palliation
basal cell margins
0.3-0.5cm
lip cancer basal (top lip)
0.75cm margin
SCC margin
1 cm, Mohs for cosmetic area
needs 2 cm margin SCC
Marjolin, penile, vulvar
node dissection for SCC if
> 2cm or >4mm deep
parotid basin lesions (ear, temple, etc.)
superficial parotidectomy, if + will need total parotidectomy and MRND
SCC need for chemo XRT
if neuro, nodal, vessel involvement or + margins
cholangiocarcinoma type I
common hepatic duct
cholangio type II
confluence of R + L hep ducts
cholangio type IIIa
spread to bifurc of R hep
cholangio type IIIb
spread to bifurc of L hep
cholangio type IV
extends to bifurc of both R and L or multifocal involvement
colangio type V
stricture @ jxn of CBD and cystic duct
increases risk of T cell lymphoma in small bowel
Celiac
marker for rhabdomyosarc
desmin
usual soft tissue sarcoma spread
hematogenous
soft tissue sarcoma usually mets to
lung
does not usually met to bone
colon cancer
most important factor in sarcoma
tumor grade
type of biopsy in soft tissue sarcoma
longitudinal excisional if < 4cm or longitudinal incisional if > 4cm
margin for soft tissue sarcoma
2 cm
chemo used if trying to limb spare in soft tissue sarcoma
doxorubicin based, also do XRT
post op chemo XRT for which soft tissue sarcoma
high grade, close margins, tumor > 5cm
soft tissue sarcoma MAID
mesna, doxarubicin, ifosfamide, dacarbazine
5 year survival for soft tissue sarcoma with resection
40%
NF1
CNS, peripheral nerve sheath, pheochromocytoma
gene in NF1
neurofibromin
gene in NF2
merlin
NF2
acoustic nerve tumor
LiFraumeni gene
p53
LiFrau cancers
breast, brain, acute leukemia, soft tissue sarcoma, adrenal cortical carcinoma
hereditary retinoblastoma gene
RB1
retinoblastoma tx
chemo, cryotherapy, radioactive plaques, laser treatment, XRT, surgery
tuberous sclerosis genes
TSC-1 : hamartin (tumor suppressor gene)
TSC-2 tuberin (mTor pathway)
manifestation of TS
hamartoma, angiomyolipoma, brain, kidney, heart, eyes, lungs, skin. Have seizures, dev delay, skin abn, lung and kidney tumors
Gardners
Au Dom - FAP + extracolonic manifestation
manifestations in Gardners
abd desmoid, osteoma of skull, thyroid ca, epidermoid cysts, fibromas
APC gene
binds GSK = glycogensysthasekinase
Merkel cell carcinoma
neuroendocrine, aggressive, spreads via skin and LN, mets to bone
stains for Merkel cell carcinoma
NSE -neuron specific enolase, cytokeratin, NF protein
tx merkel cell
SLN biopsy or LND, 2-3 cm margin, post op chemoXRT
5 year survival merkel
60%
dermatofibrosarcoma protuber RF
arsenic
margin for DFP
3cm
glomus tumor is benign T/F?
T
where to ligate if need sympathectomy for hyperhid
T2-T4
crossing nerve of kuntz
2nd rib
HPV cancer types
16 and 18
Gleevec used in
GIST, CML, recurrent or metastatic DFP
all thymomas require resection T/F
T
pleomorphic (mixed) parotid tumor
benign
warthin tumor
benign
mucoepidermoid or adenoid cystic carcinoma
malignant
acinic cell carcinoma
malignant
no risk of transmission of hepatitis with transfusion of
albumin
branched AA
leucine, isoleucine, valine
essential AA
leucine, isoleucine, valine
where are essential AA metabolized?
skeletal muscle
fibroblasts are stim by
macrophages
central cord injury
ext weak arms>legs
posterior cord injury
paraplegia with loss of propriocept and vibration, pain and temp are preserved
can enhance immune fxn
arginine
involved in collagen formation
proline
involved in signal transduction
tyrosine
involved in protein metab and citric acid cycle
glutamine
muscle protein synthesis AA
leucine
echo in blunt cardiac injury if
HD unstable
abnormal EKG in blunt cardiac injury mandates
24-48 hr stay
calcitonin
decreased Ca and Phos levels
calcitonin increased in which thyroid cancer?
medullary
calcitonin ____osteoclast activity
inhibits
where is calcitonin produced?
C cells in thyroid
Colon cancer T1
submuc
colon cancer T2
muscularis prop
colon cancer T3
subserosa
colon cancer T4a
visc peritoneum
colon cancer T4b
other organs
colon cancer N1
1-3 nodes
colon cancer stage 1
T1N0M0 or T2N0M0
colon cancer stage 2
A: T3 N0M0
B: T4 N0M0
colon cancer stage 3
A: T1N1M0 or T2N1M0
B: T3N1M0 or T4 N1M0
C: any T, N2, M0
colon cancer stage 4
any T any N M1
hereditary spherocyt
splenect after age 5, Au Dom, eval if need chole, Coombs will be negative
CPP=
MAP- ICP
risk of SSI with dirty case
30%
risk of SSI with clean
2%
risk of SSI with clean contam
4%
risk of SSI with contaminated
8%
splenic abscess tx
splenectomy
panc abscess tx
open drainage
lung abscess tx
antibiotics alone
perirectal abscess tx
open drainage
epidural abscess tx
open drainage
gold std for diagnosing C diff
stool cytotox assay, but takes 24-48
aspergillosis tx
voriconazole or amphotericin
actinomyces tx
PCN- G
nocardia tx
bactrim
SBP is usually ___microbial
mono - E coli, pneumoco, klebsiella
PD cath infections
Staph aureus
tx PD cath infection
vanc + gent, remove catheter if fungal, pseudomonas, TB
tetanus tx if clean wound and vaccinated
No TIG, no TD
digoxin mech
inhibits Na/K to increase myocardial Ca, slows AV conduction, inotropic effect
SE of digoxin
hypokalemia, arrhythmia, visual changes, decreased blood flow to intestines
ASA OD
first respiratory alkalosis then metabolic acidosis
Ambien mech
zolpidem GABA R agonist
tramadol SE
seizure
duloxetine mech
SNRI
_____ can facilitate closure of fistulas in Crohns
infliximab
tx benzo OD
flumazenil
Wilsons/Cu OD
penicillamine
hemachromotosis/Iron
deferasirox
lead poisoning tx
dimercaptosuccinic acid
drotecogin alfa activated
activated prot C used to prevent thrombosis in septic patients
fast onset, less myocardial depression, less laryngospasm
sevoflurane
pungent and airway irritation
desflurane and isoflurane
enoflurance SE
seizure
halothane
slow onset, highest myocardial depression and arrhythmias, least pungent
halothane SE
hepatitis, fever, eosinophilia, jaundice, increased LFTs
caloric requirement a. 0-1 b. 1-7 c. 7-12 d. 12-18 e >18
kcal/kg/day
a. 90-125
b. 75-90
c. 60-75
d. 30-60
e. 25-30
FW deficit =
TBW x (serum Na-140)/140
TBW =
in men weight x 0.6 in women weight x 0.5
adrenocortical carcinoma stage I
< 5 cm no local invasion, no mets
adrenocortical carcinoma stage 2
> 5cm, no local invasion, no mets
adrenocortical carcinoma stage 3
any T, any N, M0
adrenocortical carcinoma stage 4
M1
potency of steroids
hydrocort < predni < methylpred < dexameth
finasteride mech
5 alpha reductase inhibitor
tx of mediastinitis
debridement and flaps
hepatoblastoma
6 mo - 3 yrs, increased AFP, most p/w unresectable disease, associated with Beckwith-Wiedemann
malignant phyllodes mets to
lungs
Tetralogy of Fallot
overriding aorta, VSD, R vent outflow obst, RVH
highest MAC
NO
CI to using NO
PTX, SBO
Ranson criteria
WBC > 16, age >55, glucose >200 Hct decrease 10%, Ca <8 fluid >6L
avoid this anesthesia agent if egg allergy
propofol
paralysis first to go
face
paralysis last to go
diaphragm
paralysis first to recover
diaphragm
paralysis last to recover
face
undergoes hoffman elimination
cisatracuronium
rocuronium metab in
liver
pancuronium metab in
kidney
max dose lidocaine
5mg/kg
max dose marcaine/bupiv
3mg/kg
avoid this benzo in pregnancy
versed (midazolam)
calories needed in burn patient
25kcal/kg/day + 30kcal/day x %burn
protein needed in burn patient
1-1.5 g/kg/day + 3gx % burn
harris benedict equation
calculates basal metabolic rate from weight, age, height and gender
medium and short chain FA enter
portal system after entering enterocytes by simple diffusion
long chain FA enter
lymphatics (they enter along with chylomicrons)
FA synthesis occurs where
cytoplasm
saturated FA are used by
liver and heart
majority of body total cholesterol
is synthesized, not dietary
essential FAs
linoleic and linolenic
sucrose=
fruc + gluc
lactose =
galact + gluc
maltose =
gluc + gluc
Refeeding syndrome
decreased K, Mg, Phos
S phase specific agents
MTX, 5FU, pemetrexed, gemcitabine, etoposide, doxorubicin
SERMs
Tamoxifen - premenopausal, Raloxifene - post menopausal
MEN1
pit adenoma, parathyroid hyperplasia, panc tumor
MEN 2A
parathyroid hyperplasia, MTC, pheo
MEN 2B
mucosal neuroma, marfanoid, MTC, pheo
parathyroid hyperplasia, MTC, pheo
MEN 2A
pituitary adenoma, parathyroid hyperplasia, panc tumor
MEN1
mucosal neuroma, MTC, marfanoid, MTC, pheo
MEN2 B
