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What medication should be used for long-term anticoagulation of patients in renal failure.
Warfarin - Vit K antagonist. Inhibit vitamin k epoxide reductase.
(Vitamin K activates factors through gamma carboxylation)
Signs of disseminated candidiasis
muscle pain, skin rash with erythema and papules, fever
Most effective medication for controlling ulcers/symptoms in patients with a gastrinoma?
PPI’s
MoA for Flagyl
produces oxygen free radicals which disruption helical DNA structure
MoA for Fluoroquinolones
Inhibit DNA gyrase which inhibits relaxation of DNA supercoils
MoA for tetracyclines and aminoglycosides
Inhibition of 30s ribosomal subunit which in turn disrupts protein synthesis
MoA for Macrolides
Inhibition of 50s ribosomal subunit
also MoA for clarithromycin and linezolid
Greater omentum blood supply?
right and left gastro-epiploic arteries
Recurrence rate for appendicitis
7%. Interval appendectomies are not done to prevent recurrence, they are more to rule out malignancy.
What cytokines do macrophages secrete?
TNF-alpha, IL-1, IL-6, and IL-8
Where do the umbilical arteries come off of in fetal circulation?
Umbilical arteries come off of INTERNAL iliac arteries
What HPV strains are associated with genital warts?
Which ones are associated with dysplasia and cancer?
6 & 11 give warts
16 & 18 are dysplastic
First line reversal agent for tPA?
Cryoprecipitate or e-aminocaproic acid?
First line reversal agent for heparin?
protamine sulfate
What non-depolarizing paralytic has Hofman degradation and is safe for liver/renal failure patients?
Atracurium
And Cisatracurium, an isomer of atracurium
MCC of jugular vein suppurative thrombophlebitis?
pharyngitis
MCC of acute liver failure in Western world?
…in the developing world?
Tylenol overdose
Hepatitis B
Cetuximab is used against what?
EGFR and is used in Colon as well as head and neck cancer. It is not useful in KRAS +.
Rituximab is used against what?
CD20 in the treatment of lymphoma and CLL.
Imatinib is used against what?
C-KIT and ABL in the treatment of GIST and CML.
Erlotinib is used against what?
EGFR in the treatment of lung and pancreatic cancers.
cilostazol is contraindicated in who?
CHF patients
histoplasmosis symptoms
is characterized by non-specific respiratory symptoms, often cough or flu-like. Chest X-ray findings are normal in 40–70% of cases.
Lesions tend to calcify as they heal.
Severe infections treated with Amphotericin B and followed with itraconazole.
Significance of D-dimer testing for DVT
A negative d-dimer is highly predictive of a not having a DVT.
A positive test does not meant DVT though, further workup is needed.
It’s a good rule-out test.
Local anesthetics MoA?
2 types and characteristics?
Blockage of sodium channels preventing depolarization.
Amino esters (one 'i') - procaine, chloroprocaine, and tetracaine Metabolized in plasma by cholinesterases Breaksdown into PABA which can cause allergic reactions
Amino amides (two 'i's) - lidocaine, mepivacaine, prilocaine, bupivacaine, and ropivacaine Marcaine is actually bupivacaine Metabolized in the liver Lidocaine halflife is 30-90 minutes Bupivacaine halflife is 4-6 hours
What is the path of the thoracic duct?
- originates at the cisterna chyli at T10-L3
- courses superior through the aortic hiatus to the right of the aorta
- crosses to the left at T4-T5 POSTERIOR to the aortic arch
- then empties in to the left jugulo-subclavian vein junction.
Treatment for medullary thyroid cancer?
Total Thyroidectomy WITH a central neck dissection.
If evidence of mets to lateral lymph nodes then add a lateral neck dissection as well.
Normal UES and LES pressures?
Normal UES resting pressure is 50-70mmHg
Normal LES resting pressure is 10-20mmHg
Pressures when swallowing approach 0mmHg
Abnormal findings on esophageal manometry:
Normal amplitude, normal contractions, high LES pressure
Low amplitude, simultaneous contractions, high LES
Low amplitude, simultaneous, normal or low LES
Low amplitude, non-transmitted contractions, normal LES
High amplitude, long contractions, normal LES
- hypertensive LES
- achalasia
- scleroderma (treat the scleroderma first)
- ineffective esophagus motility
- nut-cracker esophagus
What is the MMC cycle and what stimulates it?
Migrating myoelectrlic complex
Phase I – quiescence;
Phase II – Increased frequency of action potentials and smooth muscle contractility;
Phase III – A few minutes of peak electrical and mechanical activity; MMC is at its peak plasma level.
Phase IV – Declining activity which merges with the next Phase I.
MC bacteria in SBP?
Usually one organism or multiple?
Tx?
Escherichia coli, Klebsiella pneumonia, and pneumococci.
Usually one organism, if many then consider other diagnosis.
3rd gen cephalosporin - ie cefotaxime
Endoleak types?
Which need immediate repair?
Treatments?
1 - where the graft meets the vessel - needs immediate repair, usually with balloon dilation
2 - from another vessel communicating with the aneurysm, ie lumbar artery - observe or angioembolization
3 - where the graft meets another graft - needs immediate repair, usually needs another stent to cover the defect
4 - graft porosity or suture holes - observe or place non-porous stent
5 - endotension, expansion without sign of leak - repeat EVAR or open repair
Triglyceride level required to diagnose chylothorax?
Presence of chylomicrons on lipoprotein analysis and a triglyceride level of more than 110 mg/dL.
Goal values of trauma resuscitation after damage control? PT, INR Fibrinogen Platelets Body temp
PT < 15 or INR < 1.2 - FFP, vitamin K, calcium and limited use of crystalloids
Fibrinogen > 100 - cryoprecipitate or fibrinogen concentrate
Platelets > 100,000 - packed platelets
Heating to temperature of 37 C (98.6 F)
Which coagulation factor has the shortest half-life?
Which has the longest?
Shortest = Factor 7 - 5 hours Longest = Factor 8 - 200 hours
Lymphatic drainage of the cervix and vagina?
internal iliac nodes
Ranson’s criteria
Corresponding mortality?
On admission: Glucose > 200 AST > 250 U/L LDH > 350 U/L Age > 55 years WBC > 16 x 109cells/L
After 48 hours: Calcium < 8.0 Hematocrit fall > 10pts O2<60 mmHg BUN increase from admission > 5 Base deficit > 4 mEq/L Sequestrated fluids > 6L
1 or 2 - 1% mortality
3 to 4 – 15% mortality
5 to 6 – 40%
> 6 – 90% - 100%
MCC of death in FAP patients after Total colectomy? How to detect?
2nd MCC of death…? Appearance on histology? Treatment?
periampillary tumors. So need EGD q1-2 years with side-viewing scope.
Desmoid tumors.
Cytologically bland fibrous neoplasm with local infiltration.
Treated with tamoxifen, NSAIDS, or Sulindac
What is a D1 dissection?
D2?
D3?
D1 = Resection of the lymph nodes at the greater and lesser curvature. D2 = D1 + around CHA, celia axis, left gastric and splenic arteries D3 = D2 + LN's in the hepatoduodenal ligament and the root of the mesentery
most common functioning pancreatic neuroendocrine tumor overall, the most common neuroendocrine tumor in MEN 1, and the neuroendocrine tumor with the least malignant potential, in that order?
Insulinoma
Gastrinoma
Insulinoma
What is the McVay repair anchoring?
anchoring the conjoint tendon to Coopers ligament thereby obliterating the femoral space.
MoA of digoxin?
Reversibly inhibits sodium, potassium-ATPase enzymes.
Leads to increase intracellular sodium which is then exchanged for calcium, increasing intracellular calcium and resulting in positive inotropy.
Side-affect is increased extracellular potassium.
what is the shortest course of antibiotic therapy that is comparable to a longer course of antibiotics once source control is achieved with an operation?
4 days.
Signs of propofol infusion syndrome?
cardiac failure, rhabdomyolysis, metabolic acidosis, and kidney failure, and is often fatal
