Rosh Material #1 Flashcards
1
Q
types of thyroid cancers mc to lc and their most significant rf
A
-papillary -> head/neck xrt
-follicular -> iodine deficiency
-medullary -> MEN2 (medullary thyroid ca, hyperparathyroid, pheocromocytoma)
-anaplastic -> presents w. dyshpagia/hoarseness
2
Q
tx for AAA based on size
A
4.0-4.9 cm: annual US
5.0-5.4 cm: US q 6 mos
>5.5 cm or rapid expansion: elective surgery
3
Q
what is ogilvie syndrome
A
massive dilation of the colon w.o mechanical obstruction
4
Q
ogilvie syndrome is due to _ dysfxn
A
autonomic
5
Q
3 rf for ogilvie syndrome
A
older age
bedbound
comorbidities
epidural anesthetics
meds
6
Q
4 meds associated w. ogilvie syndrome
A
anticholinergics
antipsychotics
dopaminergics
opioids
7
Q
supportive care can be used for ogilvie syndrome if the cecal diameter is < _
A
12 cm
8
Q
supportive care for ogilvie syndrome
A
colonic decompression
neostigmine
due to opioids: methylnaltrexone
9
Q
gs imaging for ogilvie syndrome
A
CT
10
Q
major risk of anal fissure surgery
A
irreversible fecal incontinence
11
Q
2 common indications for 1/2 NS
A
hypernatremia
DKA
12
Q
2 s.e of 1/2 NS
A
fluid overload
pulmonary edema
13
Q
most appropriate IVF for pre op pt who is NPO
A
LR
14
Q
what are the vit K clotting factors
A
II
VII
IX
X
15
Q
management of warfarin based on INR
A
-greater than goal, but < 5: skip next dose
-5-10, no bleeding risk: skip next 1-2 doses
->10, no bleeding or mod risk of bleeding: hold warfarin, give vit K
-> 10, serious bleeding or high risk for bleed: hold warfarin, give vit K and 4 factor prothrombin complex
-life threatening bleed: hold warfarin, give ffp and IV vit K
16
Q
4 meds that cause pseudotumor cerebri
A
vit A derivatives
OCPs
steroids
tetracyclines
17
Q
tx for pseudotumor cerebri
A
low Na diet
wt loss
acetazolamide
optic n sheath fenestration
shunt
18
Q
dx for pseudotumor cerebri (2)
A
MRI w. venography
LP
19
Q
how is hydrostatic reduction performed for intussusception (2)
A
barium enema
pneumatic reduction
20
Q
best test for h. pylori if a pt has an actively bleeding ulcer, a recent ppi, or recent abx use (2)
A
stool antigen
vs
urea breath
21
Q
best h. pylori testing if the pt is undergoing endoscopy, has a bleeding ulcer, or has recent ppi or abx use
A
biopsy urease during the procedure
22
Q
slow growing neuroendocrine ca that arises from enterochromaffin cells of the digestive tract - commonly arise from SI, bronchus/lung, rectum
A
carcinoid tumor
23
Q
5 sx of carcinoid tumor
A
diarrhea
flushing
wheezing
hemodynamic instability
metabolic acidosis
24
Q
24 hr urine collection findings of carcinoid tumor
A
elevated 5-HIAA (5 hydroxyindoleacetic acid)
25
tumor marker for carcinoid tumor
chromogranin A
26
when performing excisional or shave bx of a suspected melanoma a _ margin should be maintained to minimize skin loss and reduce risk for missed dx
2 mm
27
when would you order ionized Ca if you suspect hyperparathyroidism
if Ca is normal
if it is high, then order PTH
28
gs dx for peripheral lung lesion
open lung bx
29
order of imaging for wilms tumor
1. US - initial
2. CT vs MRI
3. bx - definitive
30
what is this showing
mediastinal air -> boerhaave syndrome
31
what is boerhaave syndrome
spontaneous perforation of the esophagus from sudden increase in intraesophageal pressure -
**ex sudden onset of coughing/forceful vomiting**
32
boerhaave syndrome mc involves the
left posterolateral aspect of the distal intrathoracic esophagus
33
hallmark PE finding of boerhaave syndrome
hamman crunch -> mediastinal crackling w each heartbeat
34
gs dx for boerhaave syndrome
esophagram w. water-soluble contrast
35
tx for boerhaave syndrome
emergent surgical consult
broad spectrum abx
36
what meds decrease mortality in STEMIs
-ASA
-P2Y12 receptor blockers (tigagrelor/prasugrel)
*not clopidogrel*
37
only tx for adrenocortical carcinoma
surgery
38
management of breast pain based on age
< 30: US of painful breast
30-39: US PLUS focused or bilat mammogram
>40: US PLUS bilat mammogram
39
tx for SAH
nimodipine (decreases vasospasm)
40
79 yo F w. hx htn and hypercholesterolemia - month long hx of worsening, dull, aching, generalized abd pain that lasts 30 mins and is worse after eating - she is avoiding eating and has lost 8 lb x 3 weeks
chronic mesenteric ischemia
41
2 types of necrotizing fasciitis
1. polymicrobial - aerobic and anaerobic
2. GAS
42
tx for necrotizing fasciitis
surgical debridement
abx
43
mc form of intestinal ischemia
ischemic colitis
44
2 mc locations for ischemic colitis
splenic flexure
rectosigmoid junction
45
ischemic colitis is caused by a
**global low flow state:**
CHF
MI
sepsis
hemorrhage
(unlike embolic w. mesenteric ischemia)
46
3 HPI clues for ischemic colitis
atherosclerotic dz
aortoiliac surgery
cardiopulmonary bypass
47
tx for ischemic colitis
supportive
48
what is paget-schroetter syndrome
primary upper DVT
49
5 hpi clues for paget-schroetter syndrome
-muscular
-repetitive overarm hyperabduction/external rotation
-strenuous activity
-central line placement
-hypercoagulable state
50
paget-schroetter syndrome is caused by
compressive anomaly at the thoracic outlet
51
tx for paget-schroetter syndrome
NSAIDs
alteplase
heparin
venoplasty
compression stockings
52
which type of adenomatous polyps have the greatest risk of malignancy
villous
53
PLT transfusion thresholds for pt's w. thrombocytopenia
CNS/ocular bleeding: <100,000
active bleeding: < 50,000
nonbleeding: < 10,000
54
direct visualization tests for colon ca screening and frequency they need to be performed
colonoscopy: q 10 yr
CT colonography: q 5 yr
flexible sigmoidoscopy: q 5 yr
flexible sigmoidoscopy PLUS FIT annually: 1 10 yr
55
what are the 3 accepted stool based tests for colorectal ca screening and frequency they need to be performed
gFOBT: annually
FIT: annually
FIT-DNA: q 1-3 yr
56
what is this showing
drug induced exanthem
57
what is this showing
uticaria
58
what is this showing
cuataneous small vessel vasculitis
59
what is thsi showing
exfoliative dermatitis: chronic erythema/scale involving > 90% of the body surface
60
what is this showing
SJS
61
what is this showing
erythema multiforme
62
what is this showing
erythematous/edematous plaques w. grayish center or frank bullae -> fixed drug rxn
63
tx for drug induced exanthems
topical tiramcinolone
PO hydroxyzine
64
most aggressive type of breast ca
triple negative
65
what is this showing
achalasia: loss of inhibitory neurons in the distal 2/3 of the esophagus -> absent peristalsis and increased tone in the LES
66
4 sx of achalasia
dysphagia to liquids and solids
CP
weight loss
regurgitation
67
dx for achalasia: initial vs gs
initial: EGD
gs: esophageal manometry
68
tx for achalasia (3)
graded pneumatic dilation
esophageal botulism
surgical myotomy
69
types of dysphagia and associated conditions
odynophagia: infectious esophagitis
progressive: stricture/ring/web/tumor
intermittent: eosinophilic esophagitis
liquid: dysmotility (infective vs achalasia)
halitosis/regurgitation of undigested food: zenker
abrupt onset: pill or chemical esophagitis
70
chest discomfort precipitated by activity
sx abate after activity
stable angina
71
ischemic sx suggestive of acute coronary syndrome
+/- ECG changes indicative of ischemia
unstable angina
72
troponin elevation
subendocardial ischemia
ECG w. ST depressions
NSTEMI
73
troponin elevation
transmural ischemia
ECG w. ST elevation
STEMI
74
what is this showing
diffuse increased iodine uptake in both thyroid lobes -> **graves dz**
75
what is this showing
normal thyroid
76
what is this showing
toxic multinodular goiter -> plummer dz
77
what is this showing
toxic adenoma
78
what is this showing
thyroiditis
79
management of thyroid nodules
benign: monitor q 12 mos
intermediate nodules: repeat FNA, molecular testing, diagnostic lobectomy
suspicious nodules: surgery
80
what is this showing
aortic dissection
81
abi < 0.9 indicates:
abi < 0.4 indicates
< 0.9 = > 50% stenosis
< 0.4 - ischemia
82
order of dx studies for PAD
1. resting ABI
2. toe-brachial
3. exercise ABI (if dx unsure)
83
tx of hypoglycemia in diabetic pt's based on BG
**asymptomatic w. BG
84
3endoscopic features of a peptic ulcer suggestive of malignancy
-ulcerated mass protruding into lumen
-nodular/clubbed/fused folds surrounding ulcer
-overhanging, irregular, or thickened margins
85
mc type of gastric ca
adenocarcinoma
86
tx for toxic megacolon
subtotal colectomy w.end ileostomy
87
what is boas sign
hyperaesthesia, increased or altered sensitivy below the right scapula -> **cholecystitis**
88
what type of cholecystitis occurs in critically ill pt's
acalculous
89
gs dx for cholecystitis
HIDA (cholescintigraphy)
90
pharm management of esophageal varices (3)
ocretotide -> decreases bleeding
vasopressin -> reduces portal pressure
bb -> secondary bleeding prophylaxis (not for acute)
91
endoscopic management of esophageal varices
banding ligation - preferred
sclerotherapy - high rate of rebleeding
92
downsides of balloon tamponade for esophageal varices
only temporary
many complications: aspiration death, perforation
pt needs to be intubated
93
indications for TIPS for esophageal varices
refractory
rebleeding
94
surgery for esophageal varices
PCS (esophageal transection or portacaval shunt)
95
2 abx for esophgeal varices
ceftriaxone
norfloxacin
96
order of tx for esophageal varices
1. endoscopic band ligation vs sclerotherapy
2. balloon tamponade (if endoscopic fails)
97
tx for cdiff
vanco vs fidaxomicin
98
what is this showing
corkscrew esophagus -> **esophageal spasm**
99
impairment of inhibitory innervation to the esophagus -> leads to both premature and rapidly prolonged or simultaneous contractions in the distal esophagus
esophageal spasm
100
dx for esophageal sapsm
esophageal manometry
101
tx for esophageal spasm
**ccb**
**tca**
isodorbide-sildenafil
botulinum
102
first line surgical tx for achalasia
laparascopic heller myotomy
103
what is this showing
apple core lesion -> colorectal ca
104
what is this showing
bcc
105
basophilic staining cells with peripheral palisading nuclei
bcc
106
grades of hepatic encephalopathy
I: disordered sleep, dpn, irritability, mild cognitive dysfxn
II: lethargy, confusion, personality changes, disorientation, asterixis
III: somnolence, confusion, inability to follow commands, disorientation
IV: coma
107
tx for hepatic encephalopathy
lacutlose
rifamixin
108
_ correlates w. severeity of hepatic encepalopathy
CSF glutamine
109
t/f: atelectasis is mc asymptomatic unless the pt develops hypoxemia or pna
110
2 types of choledocholithiasis
primary: stone originates in cbd
secondary: stone originates in gallbladder -> cbd
111
types of stone mc found in primary vs secondary choledocholithiasis
primary: pigmented (brown)
secondary: cholesterol vs mixed
112
what is this showing
u-shaped bent inner tube -> **sigmoid volvulus**
113
4 rf for sigmoid volvulus
ltc pt's
advanced age
bedridden
chronic constipation
114
tx for sigmoid volvulus
flexible sigmoidoscopy -> reduces volvulus
surgery -> prevents recurrence
115
management of asthma patients pre op
SABA vs nebulizer 30 min prior to surgery if intubation is needed
116
what is this showing
pyloric stenosis
117
duodenum w. a corkscrew appearance
volvulus
118
whirlpool sign noted w. craniocaudal movement of US transducer
volvulus
119
string sign
pyloric stenosis
120
breast bx options
core needle -> preferred initiallyl
FNA -> intraprocedural
surgical
skin punch -> consider for paget's/inflammatory
121
6 rf for incisional hernia
old age
obesity
smoking
malnutrition
immunosuppressive therapy
connective tissue d.o
122
imaging for aortic dissection
hemodynamically unstable: TEE
hemodynamically stable: CTA vs MRA
123
mc location from which hemorrhoids arise
superior hemorrhoidal cushion
124
mcc of larg bowel obstruction: benign vs non-benign
benign: volvulus
non-benign: colorectal ca
125
mc location for large bowel obstruction
sigmoid colon
126
clotting labs associated w. DIC
elevated: PT, PTT, thrombin clotting time, fibrin split products
low: PLT, fibrinogen
127
post prandial pain w. duodenal ulcers occurs _ after eating food
2-5 hr
128
location of PAD based on pain
calf -> distal superficial femoral a
behind knee, into calf -> popliteal a
thigh/lower leg -> deep femoral a (uncommon)
thigh/buttocks -> common iliac a
129
irregular erythematous plaque w. a hemorrhagic crust
scc
130
2 mc indications for preop dialysis
hyperkalemia
fluid overload
131
what is this showing
aortic dissection
132
sx of type A vs type B aortic dissection
type A: chest pain radiating to the back, syncope
type B: HTN
133
order of managemetn for aortic dissection
1. bb - labetalol vs esmolol
2. nitroprusside for further bp control
3. morphine
4. type A: emergent surgery
134
indication for surgery for type B aortic dissection
end organ damage
htn refractory to meds
135
what surgery is preferred for type B aortic dissection
thoracic stent graft repair
136
mc presentation of an obturator hernia
female 70-90 yo
SBO
137
what PE sign is associated w. obturator hernias
howship-romberg: pain extends down the medial aspect of the thigh w. movement of the knee
138
3 sites for central line access based on risk of infxn: low to high
subclavian
interna jugular
femoral
139
which presentation is chronic GERD mc associated w. in terms of metaplasia
columnar metaplasia of the squamous epithelium
140
where do adenocarcinomas of the esophagus mc occur
distal 1/3 of the esophagus near the gastroesophageal junction
141
where does squamous cell carcinoma of the esophagus occur
proximal 2/3 of the esophagus
142
2 mc rf for adenocarcinoma of the esophagus
barrett esophagus
obesity
143
2 mc rf for squamous cell carcinoma of the esophagus
chronic etoh
tobacco
144
cobblestoning
skip lesions
transmural inflammation
crohn dz
145
what is the recommended minimum pre op PLT count based on procedure
-transfuse if <10,000: hematologic malignancies, allogenic hematopoietic cell transplant, solid tumors
-transfuse if < 40,000-50,000: major procedures
-transfuse if <20,000: bone marrow aspirate, insertion/removal of a central line
146
normal ALP/ALT/AST with jaundice
gilbert syndrome
crigler-najjar syndrome
147
elevated ALP elevation greater than ALT/AST elevation
intrahepatic cholestasis
biliary obstruction
148
eleavted GGT and ALP
cholestasis
149
5 causes of AST elevation
etoh
APAP
NSAIDs
ACEI
abx
150
AST:ALT > 2
etoh hepatitis
151
AST: ALT < 1
hepatocellular necrosis
152
causes of ALP elevation
hepatocellular dz
cholestatic dz
may be normal in healthy kids and pregnant
153
causes of elevated GGT
etoh
phenobarbital
warfarin
