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Absite Review > SCORE questions > Flashcards

SCORE questions Flashcards

1
Q

What are the two histologic subtypes of Rhabdomyosarcoma?

A
  1. Embryonal (most common)

2. Alveolar

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2
Q

what are the different types of embryonal rhabdomyosarcoma? (2)

A
  1. Spindle cell- most common in paratesticular lesions

2. Botryoid- polypoid masses that fill the lumen of a hollow viscus (vagina, bladder)

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3
Q

Embyonal rhabdomyosarcoma:

  1. young vs old
  2. survival?
A
  1. Occurs in younger patients, head and neck region

2. Favorable survival rate 60%

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4
Q

What is roving sign?

A

right lower quadrant pain induced by palpation in the left lower quadrant (for acute appendicitis)

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5
Q

What is dunphy sign?

A

increased pain with any coughing or movement and is related to inflammation that involves the parietal peritoneum

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6
Q

what is the obturator sign?

A

seen with inflammation of the appendix and refers to pain on internal rotation of the right hip

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7
Q

what is the iliopsoas sign?

A

most often seen with a rhetorical appendix and refers to pain on extension of the right hip

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8
Q

What is immune thrombocytopenia purpura (ITP)?

A

autoimmune destruction of platelets with clinical manifestations of thrombocytopenia and susceptibility to easy bleeding

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9
Q

What patient population does acute ITP target?

A

children

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10
Q

What is chronic ITP?

A
  • accounts for most cases considered for splenectomy

- avg age 40’s, women > men

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11
Q

What is the pathophys of ITP?

A

development of IgG antibody to platelet antigen

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12
Q

First, second and third line treatment of ITP?

A

1st: high dose steroids
2nd: IVIG
3rd: splenectomy

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13
Q

What 3 things does End tidal CO2 monitoring reflect?

A
  1. Metabolism
  2. Circulation
  3. Ventilation
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14
Q

In which breast malignancy should patients proceed directly to axillary lymph node dissection?

A

Inflammatory breast cancer

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15
Q

What non depolarizing muscle relaxant is preferred for endotracheal intubation in patients with either hepatic or renal dysfunction?

A

Atracurium: (dose 0.3-0.6mg/kg), Hoffman elimination thus good for renal/hepatic impaired ppl, can cause histamine release leading to hypotension

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16
Q

What is Hoffman elimination? i.e. a type of metabolism

A

spontaneous degradation of drug at physiologic pH

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17
Q

Why is vecuronium the intubation drug of choice in reactive airway patients?

A

because it doesn’t cause histamine release upon administration. (hepatic metabolism, 0.1mg/kg)

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18
Q

What is the longest acting of all muscle relaxants?

A

doxacurium (max effect at 6 min and duration of action is 83 min)

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19
Q

What is the most common primary lung tumor among infants and children?

A

Bronchial adenoma- 80% of these are Endobronchial carcinoid

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20
Q

what is the most common benign tumor of the lung in children?

A
  • rare!! but most common is pulmonary hamartoma or chondroma
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21
Q

what stimulates the secretion of aldosterone?

A

extracellular fluid potassium

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22
Q

when compared with endoscopic sphincterotomy, transduodenal sphincteroplasty is associated with what?

A

decreased incidence of restenosis

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23
Q

what is a giant condyloma acuminatum? aka Burschke-Lowenstein tumor

A
  • represents verrucous carcinoma
  • large cauliflower lesion
  • histologically benign but clinically malignant and can invade adjacent organs
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24
Q

Whats one disadvantage of Lactated ringers?

A

its relatively low sodium content (130 mEq) , hyponatremia can occur with prolonged use

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25
Q

What are the factors that negatively affect post-transplant outcomes?

A
  1. Increased donor age >50
  2. Female sex of donor
  3. Increased hepatic steatosis of the donor liver
  4. Severe donor hypernatremia prior to organ harvest
  5. Prolonged cold ischemia time
  6. ABO mismatach
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26
Q

most common presentation of branchial anomaly in adolescent is?

A

cystic mass (arising from the second cleft/pouch)

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27
Q

What are the phases of the cell cycle?

A 
G1, S, G2, M
M: mitosis
S: DNA Synthesis
G1: gap1 separates previous cell division from the beginning of the DNA synthesis, determines length of cycle
G2: short gap phase
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28
Q

a neonate with hypo plastic left heart syndrome depends on what for survival?

A

patency of the facts arteriosus (facilitated by prostaglandin infusion)

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29
Q

What are 2 treatment options for hypo plastic left heart syndrome?

A
  1. Cardiac transplantation requiring a donor aortic arch

2. Norwood procedure: converts the pulmonary artery into the main outlet for a functional single ventricle

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30
Q

what is an important principle with bypass grafting for aortoiliac occlusive disease?

A

place the proximal anastomosis as high as possible on the infrarenal aorta

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31
Q

the distal anastomosis of a bypass graft for aortoiliac occlusive disease is almost always where?

A

at the level of the femoral artery

32
Q

what are some pathognomonic changes of CF seen in intestinal or appendiceal specimens?

A

goblet cell hyperplasia and the accumulation of secretions within the crypts or lumen

33
Q

what is the major cause of death in children with spinal cord injury?

A

respiratory failure

34
Q

Define: T1 gallbladder cancer and tx

A

limited to the muscular wall of the gallbladder

tx: simple cholecystectomy

35
Q

Define: T2 gallbladder cancer and tx

A

T2: full thickness invasion into the perimuscular connective tissue but not the serosa
Tx: radical cholecystectomy with resection of segments IVb and V of the liver + regional lymphadenectomy

36
Q

formula for respiratory quotient, RQ’s for:

  • ethanol
  • fat
  • protein
  • carbs
  • lipogenesis
A 
RQ =  VCO2/VO2
Ethanol  = 0.67
Fat = 0.7
protein  = 0.8
carbs = 1.0
lipogenesis >1.0
37
Q

what are the three positive pulse waves of normal JVP?

A

a = atrial contraction, relates to S4
c = bulging of the AV valve into the atrium during isovolumetric ventricular systole
v = passive atrial filling from the vena cava
two neg descents:
x = atrial relaxation
y = passive ventricular filling (follows opening of AV valve)

38
Q

What pulmonary to systemic blood flow ratio indicates that an ASD should be repaired?

A
  • marked left to right shunt, seen by a ratio >1.5
39
Q

when is a patient with an ASD not a candidate for repair?

A

when pulmonary vascular resistance is >10-12 wood units/m2 (indicates fixed pulmonary hypertension)

40
Q

how do you manage DVTs resulting from upper extremity central venous lines?

A

catheter removal, heparin therapy, long term oral anticoagulants (3-6 months)

41
Q

In patients with hepatocellular carcinoma, how do you determine who’s a candidate for major hepatectomy?

A
  • hepatic function measured by indocyanine green (ICG)

- ICG retention > 14% at 15 minutes = major rsxn shouldn’t be performed

42
Q

what is the single most important determinant of long term survival in patients with hepatocellular carcinoma?

A

vascular invasion

43
Q

what are 6 variables that adversely affect 5yr survival in patients w Hepatocellular carcinoma?

A
  1. Vascular invasion most important
  2. multiplicity of lesions
  3. Presence of symptoms
    • resected margins
  5. tumor size >5cm
  6. Absence of tumor capsule
44
Q

Preferred treatment of spontaneously ruptured hepatocellular tumors?

A

packing, hepatic artery ligation and transarterial embolization

45
Q

Given an infant with hypertrophic pyloric stenosis, the expected electrolyte abnormalities include:

A

hypochloremic, hypokalemic metabolic alkalosis

46
Q

what is the age range for appendicitis to occur most frequently?

A

8-12

47
Q

all intrathoracic vascular pressures are measured at which point in the respiratory cycle?

A

end expiratory pressure (lowest point in the resp cycle)

48
Q

what is the mainstay of treatment for frostbite?

A

rapid rewarming in a 40C water bath

49
Q

what are the milan criteria used for selection of pts w HCC who get transplant?

A
  • absence of macrovascular invasion and:

- a single tumor

50
Q

what is the most likely presentation of a third branchial anomaly?

A

infection: 3rd and 4th branchial anomalies mostly present as sinuses or infected cysts. look for hx of repeated URI, sore throats, hoarseness, and tenderness of thyroid gland

51
Q

What is hypoxic pulmonary vasoconstriction?

A

phenomenon in which pulmonary blood flow is redistributed to better-ventilated areas of the lung in response to hypoxia

52
Q

severe neonatal respiratory failure is treated most effectively by?

A

ECMO

53
Q

In pots with penetrating abdominal injuries, which 6 factors reveal increased infection rates?

A
  1. Colon injury
  2. blood txfn requirement
  3. hypotension
  4. multiple intra-abdominal organ injuries
  5. late administration of abx
  6. increasing age
  7. BAC >200
54
Q

airway of choice for a patient w severe laryngeal trauma?

A

immediate tracheostomy

55
Q

five year survival for patients with adrenocortical carcinoma?

A

20-25%

56
Q

what is early graft failure? definition

A
  • occurs within 30days postop

- usually 2/2 technical or judgment error (twists, kinks)

57
Q

what is intermediate graft failure? definition

A
  • occurs 30days to 2 years

- usually 2/2 intimal hyperplasia at anastomotic sites

58
Q

what is late graft failure? definition

A
  • occurs >2 years postoperatively

- usually 2/2 progressive atherosclerotic disease

59
Q

what is the most common type of neoplasia identified in a meckel’s diverticulum?

A

carcinoid

tx: excision of that segment of ileum and assoc mesentery

60
Q

what is budd-chiari syndrome? symptoms?

A

rare disease cause by mechanical obstruction of the hepatic veins (terminal veins to vena cava)
symptoms: abdominal pain, hepatomegaly, ascites

61
Q

how do you diagnose budd chiari syndrome?

A

duplex doppler US (85-95 sensitivity)

can also use CT

62
Q

what are the causes of budd chiari syndrome?

A

africa and asia: obstructing webs or membranes

Western: neoplasms

63
Q

what 3 bugs are most commonly seen with bacterial meningitis following epidural placement?

A
  1. Staph aureus
  2. Coliform species
  3. Pseudomonas
64
Q

what is receptive relaxation of the stomach and what controls it?

A
  • with ingestion of a meal, increasing gastric volumes are accommodated with little increase in intragastric pressure by relaxation of the proximal stomach
  • mediated by a reflex carried by the vagal nerve
65
Q

what is fitz-hugh-curtis syndrome?

A
  • from pelvic inflammatory disease theres a migration of bacteria into the peritoneum leading to inflammation and adhesions between the liver and the peritoneal lining
66
Q

how do you repair an annular pancreas?

A

duodenoduodenostomy

67
Q

what do you do when a patient has a severe lower GI bleed and you suspect internal hemorrhoids?

A

anoscopy

68
Q

an ABI less than what is diagnostic of PAD?

A

0.9

69
Q

What is Beck’s triad?

A
  • three classic signs of cardiac tamponade
    1. Decreased arterial pressure
    2. elevated JVP
    3. muffled heart sounds
70
Q

whats pulsus paradoxus?

A

a fall in systolic pressure of more than 10mmHg during inspiration as seen in cardiac tamponade

71
Q

what is the standard therapy for acute epiglottitis in a child?

A

endotracheal intubation in the operating room and IV antibiotic therapy

72
Q

whats almost always the cause of acute epiglottitis in a child?

A

H. influenzae B

73
Q

the virus associated with nasopharyngeal carcinoma and Burkitt’s lymphoma?

A

EBV

74
Q

what is neurogenic shock?

A

failure of the nervous system to rovide effective peripheral vascular resistance, resulting in inadequate end-organ perfusion

75
Q

what are the symptoms of neurogenic shock? (5)

A
  1. warm flushed flaccid extremities
  2. paraplegia
  3. contusion
  4. oliguria
  5. hypotension
76
Q

which tumor marker has the greatest specificity for the detection of hepatoblastoma?

A

AFP (76-94% specific)

77
Q

what is a traditional approach to crohn’s disease related obstruction of the first two portions of the duo?

A

a bypass with a gastrojejunostomy + highly selective vagotomy

Absite Review (30 decks)

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