SCORE questions Flashcards
What are the two histologic subtypes of Rhabdomyosarcoma?
- Embryonal (most common)
2. Alveolar
what are the different types of embryonal rhabdomyosarcoma? (2)
- Spindle cell- most common in paratesticular lesions
2. Botryoid- polypoid masses that fill the lumen of a hollow viscus (vagina, bladder)
Embyonal rhabdomyosarcoma:
- young vs old
- survival?
- Occurs in younger patients, head and neck region
2. Favorable survival rate 60%
What is roving sign?
right lower quadrant pain induced by palpation in the left lower quadrant (for acute appendicitis)
What is dunphy sign?
increased pain with any coughing or movement and is related to inflammation that involves the parietal peritoneum
what is the obturator sign?
seen with inflammation of the appendix and refers to pain on internal rotation of the right hip
what is the iliopsoas sign?
most often seen with a rhetorical appendix and refers to pain on extension of the right hip
What is immune thrombocytopenia purpura (ITP)?
autoimmune destruction of platelets with clinical manifestations of thrombocytopenia and susceptibility to easy bleeding
What patient population does acute ITP target?
children
What is chronic ITP?
- accounts for most cases considered for splenectomy
- avg age 40’s, women > men
What is the pathophys of ITP?
development of IgG antibody to platelet antigen
First, second and third line treatment of ITP?
1st: high dose steroids
2nd: IVIG
3rd: splenectomy
What 3 things does End tidal CO2 monitoring reflect?
- Metabolism
- Circulation
- Ventilation
In which breast malignancy should patients proceed directly to axillary lymph node dissection?
Inflammatory breast cancer
What non depolarizing muscle relaxant is preferred for endotracheal intubation in patients with either hepatic or renal dysfunction?
Atracurium: (dose 0.3-0.6mg/kg), Hoffman elimination thus good for renal/hepatic impaired ppl, can cause histamine release leading to hypotension
What is Hoffman elimination? i.e. a type of metabolism
spontaneous degradation of drug at physiologic pH
Why is vecuronium the intubation drug of choice in reactive airway patients?
because it doesn’t cause histamine release upon administration. (hepatic metabolism, 0.1mg/kg)
What is the longest acting of all muscle relaxants?
doxacurium (max effect at 6 min and duration of action is 83 min)
What is the most common primary lung tumor among infants and children?
Bronchial adenoma- 80% of these are Endobronchial carcinoid
what is the most common benign tumor of the lung in children?
- rare!! but most common is pulmonary hamartoma or chondroma
what stimulates the secretion of aldosterone?
extracellular fluid potassium
when compared with endoscopic sphincterotomy, transduodenal sphincteroplasty is associated with what?
decreased incidence of restenosis
what is a giant condyloma acuminatum? aka Burschke-Lowenstein tumor
- represents verrucous carcinoma
- large cauliflower lesion
- histologically benign but clinically malignant and can invade adjacent organs
Whats one disadvantage of Lactated ringers?
its relatively low sodium content (130 mEq) , hyponatremia can occur with prolonged use
What are the factors that negatively affect post-transplant outcomes?
- Increased donor age >50
- Female sex of donor
- Increased hepatic steatosis of the donor liver
- Severe donor hypernatremia prior to organ harvest
- Prolonged cold ischemia time
- ABO mismatach
most common presentation of branchial anomaly in adolescent is?
cystic mass (arising from the second cleft/pouch)
What are the phases of the cell cycle?
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
a neonate with hypo plastic left heart syndrome depends on what for survival?
patency of the facts arteriosus (facilitated by prostaglandin infusion)
What are 2 treatment options for hypo plastic left heart syndrome?
- Cardiac transplantation requiring a donor aortic arch
2. Norwood procedure: converts the pulmonary artery into the main outlet for a functional single ventricle
what is an important principle with bypass grafting for aortoiliac occlusive disease?
place the proximal anastomosis as high as possible on the infrarenal aorta
the distal anastomosis of a bypass graft for aortoiliac occlusive disease is almost always where?
at the level of the femoral artery
what are some pathognomonic changes of CF seen in intestinal or appendiceal specimens?
goblet cell hyperplasia and the accumulation of secretions within the crypts or lumen
what is the major cause of death in children with spinal cord injury?
respiratory failure
Define: T1 gallbladder cancer and tx
limited to the muscular wall of the gallbladder
tx: simple cholecystectomy
Define: T2 gallbladder cancer and tx
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
formula for respiratory quotient, RQ’s for:
- ethanol
- fat
- protein
- carbs
- lipogenesis
RQ = VCO2/VO2 Ethanol = 0.67 Fat = 0.7 protein = 0.8 carbs = 1.0 lipogenesis >1.0
what are the three positive pulse waves of normal JVP?
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)
What pulmonary to systemic blood flow ratio indicates that an ASD should be repaired?
- marked left to right shunt, seen by a ratio >1.5
when is a patient with an ASD not a candidate for repair?
when pulmonary vascular resistance is >10-12 wood units/m2 (indicates fixed pulmonary hypertension)
how do you manage DVTs resulting from upper extremity central venous lines?
catheter removal, heparin therapy, long term oral anticoagulants (3-6 months)
In patients with hepatocellular carcinoma, how do you determine who’s a candidate for major hepatectomy?
- hepatic function measured by indocyanine green (ICG)
- ICG retention > 14% at 15 minutes = major rsxn shouldn’t be performed
what is the single most important determinant of long term survival in patients with hepatocellular carcinoma?
vascular invasion
what are 6 variables that adversely affect 5yr survival in patients w Hepatocellular carcinoma?
- Vascular invasion most important
- multiplicity of lesions
- Presence of symptoms
- resected margins
- tumor size >5cm
- Absence of tumor capsule
Preferred treatment of spontaneously ruptured hepatocellular tumors?
packing, hepatic artery ligation and transarterial embolization
Given an infant with hypertrophic pyloric stenosis, the expected electrolyte abnormalities include:
hypochloremic, hypokalemic metabolic alkalosis
what is the age range for appendicitis to occur most frequently?
8-12
all intrathoracic vascular pressures are measured at which point in the respiratory cycle?
end expiratory pressure (lowest point in the resp cycle)
what is the mainstay of treatment for frostbite?
rapid rewarming in a 40C water bath
what are the milan criteria used for selection of pts w HCC who get transplant?
- absence of macrovascular invasion and:
- a single tumor
what is the most likely presentation of a third branchial anomaly?
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
What is hypoxic pulmonary vasoconstriction?
phenomenon in which pulmonary blood flow is redistributed to better-ventilated areas of the lung in response to hypoxia
severe neonatal respiratory failure is treated most effectively by?
ECMO
In pots with penetrating abdominal injuries, which 6 factors reveal increased infection rates?
- Colon injury
- blood txfn requirement
- hypotension
- multiple intra-abdominal organ injuries
- late administration of abx
- increasing age
- BAC >200
airway of choice for a patient w severe laryngeal trauma?
immediate tracheostomy
five year survival for patients with adrenocortical carcinoma?
20-25%
what is early graft failure? definition
- occurs within 30days postop
- usually 2/2 technical or judgment error (twists, kinks)
what is intermediate graft failure? definition
- occurs 30days to 2 years
- usually 2/2 intimal hyperplasia at anastomotic sites
what is late graft failure? definition
- occurs >2 years postoperatively
- usually 2/2 progressive atherosclerotic disease
what is the most common type of neoplasia identified in a meckel’s diverticulum?
carcinoid
tx: excision of that segment of ileum and assoc mesentery
what is budd-chiari syndrome? symptoms?
rare disease cause by mechanical obstruction of the hepatic veins (terminal veins to vena cava)
symptoms: abdominal pain, hepatomegaly, ascites
how do you diagnose budd chiari syndrome?
duplex doppler US (85-95 sensitivity)
can also use CT
what are the causes of budd chiari syndrome?
africa and asia: obstructing webs or membranes
Western: neoplasms
what 3 bugs are most commonly seen with bacterial meningitis following epidural placement?
- Staph aureus
- Coliform species
- Pseudomonas
what is receptive relaxation of the stomach and what controls it?
- 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
what is fitz-hugh-curtis syndrome?
- from pelvic inflammatory disease theres a migration of bacteria into the peritoneum leading to inflammation and adhesions between the liver and the peritoneal lining
how do you repair an annular pancreas?
duodenoduodenostomy
what do you do when a patient has a severe lower GI bleed and you suspect internal hemorrhoids?
anoscopy
an ABI less than what is diagnostic of PAD?
0.9
What is Beck’s triad?
- three classic signs of cardiac tamponade
1. Decreased arterial pressure
2. elevated JVP
3. muffled heart sounds
whats pulsus paradoxus?
a fall in systolic pressure of more than 10mmHg during inspiration as seen in cardiac tamponade
what is the standard therapy for acute epiglottitis in a child?
endotracheal intubation in the operating room and IV antibiotic therapy
whats almost always the cause of acute epiglottitis in a child?
H. influenzae B
the virus associated with nasopharyngeal carcinoma and Burkitt’s lymphoma?
EBV
what is neurogenic shock?
failure of the nervous system to rovide effective peripheral vascular resistance, resulting in inadequate end-organ perfusion
what are the symptoms of neurogenic shock? (5)
- warm flushed flaccid extremities
- paraplegia
- contusion
- oliguria
- hypotension
which tumor marker has the greatest specificity for the detection of hepatoblastoma?
AFP (76-94% specific)
what is a traditional approach to crohn’s disease related obstruction of the first two portions of the duo?
a bypass with a gastrojejunostomy + highly selective vagotomy
