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study stuff from truelearn practice test Flashcards

1
Q

What medication should be used for long-term anticoagulation of patients in renal failure.

A

Warfarin - Vit K antagonist. Inhibit vitamin k epoxide reductase.

(Vitamin K activates factors through gamma carboxylation)

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2
Q

Signs of disseminated candidiasis

A

muscle pain, skin rash with erythema and papules, fever

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3
Q

Most effective medication for controlling ulcers/symptoms in patients with a gastrinoma?

A

PPI’s

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4
Q

MoA for Flagyl

A

produces oxygen free radicals which disruption helical DNA structure

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5
Q

MoA for Fluoroquinolones

A

Inhibit DNA gyrase which inhibits relaxation of DNA supercoils

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6
Q

MoA for tetracyclines and aminoglycosides

A

Inhibition of 30s ribosomal subunit which in turn disrupts protein synthesis

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7
Q

MoA for Macrolides

A

Inhibition of 50s ribosomal subunit

also MoA for clarithromycin and linezolid

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8
Q

Greater omentum blood supply?

A

right and left gastro-epiploic arteries

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9
Q

Recurrence rate for appendicitis

A

7%. Interval appendectomies are not done to prevent recurrence, they are more to rule out malignancy.

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10
Q

What cytokines do macrophages secrete?

A

TNF-alpha, IL-1, IL-6, and IL-8

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11
Q

Where do the umbilical arteries come off of in fetal circulation?

A

Umbilical arteries come off of INTERNAL iliac arteries

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12
Q

What HPV strains are associated with genital warts?

Which ones are associated with dysplasia and cancer?

A

6 & 11 give warts

16 & 18 are dysplastic

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13
Q

First line reversal agent for tPA?

A

Cryoprecipitate or e-aminocaproic acid?

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14
Q

First line reversal agent for heparin?

A

protamine sulfate

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15
Q

What non-depolarizing paralytic has Hofman degradation and is safe for liver/renal failure patients?

A

Atracurium

And Cisatracurium, an isomer of atracurium

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16
Q

MCC of jugular vein suppurative thrombophlebitis?

A

pharyngitis

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17
Q

MCC of acute liver failure in Western world?

…in the developing world?

A

Tylenol overdose

Hepatitis B

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18
Q

Cetuximab is used against what?

A

EGFR and is used in Colon as well as head and neck cancer. It is not useful in KRAS +.

19
Q

Rituximab is used against what?

A

CD20 in the treatment of lymphoma and CLL.

20
Q

Imatinib is used against what?

A

C-KIT and ABL in the treatment of GIST and CML.

21
Q

Erlotinib is used against what?

A

EGFR in the treatment of lung and pancreatic cancers.

22
Q

cilostazol is contraindicated in who?

A

CHF patients

23
Q

histoplasmosis symptoms

A

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.

24
Q

Significance of D-dimer testing for DVT

A

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.

25
Q

Local anesthetics MoA?

2 types and characteristics?

A

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
26
Q

What is the path of the thoracic duct?

A
  • 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.
27
Q

Treatment for medullary thyroid cancer?

A

Total Thyroidectomy WITH a central neck dissection.

If evidence of mets to lateral lymph nodes then add a lateral neck dissection as well.

28
Q

Normal UES and LES pressures?

A

Normal UES resting pressure is 50-70mmHg
Normal LES resting pressure is 10-20mmHg
Pressures when swallowing approach 0mmHg

29
Q

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

A
  • hypertensive LES
  • achalasia
  • scleroderma (treat the scleroderma first)
  • ineffective esophagus motility
  • nut-cracker esophagus
30
Q

What is the MMC cycle and what stimulates it?

A

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.

31
Q

MC bacteria in SBP?
Usually one organism or multiple?
Tx?

A

Escherichia coli, Klebsiella pneumonia, and pneumococci.

Usually one organism, if many then consider other diagnosis.

3rd gen cephalosporin - ie cefotaxime

32
Q

Endoleak types?
Which need immediate repair?
Treatments?

A

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

33
Q

Triglyceride level required to diagnose chylothorax?

A

Presence of chylomicrons on lipoprotein analysis and a triglyceride level of more than 110 mg/dL.

34
Q 
Goal values of trauma resuscitation after damage control?
PT, INR
Fibrinogen
Platelets
Body temp
A

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)

35
Q

Which coagulation factor has the shortest half-life?

Which has the longest?

A 
Shortest = Factor 7 - 5 hours
Longest = Factor 8 - 200 hours
36
Q

Lymphatic drainage of the cervix and vagina?

A

internal iliac nodes

37
Q

Ranson’s criteria

Corresponding mortality?

A 
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%

38
Q

MCC of death in FAP patients after Total colectomy? How to detect?

2nd MCC of death…? Appearance on histology? Treatment?

A

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

39
Q

What is a D1 dissection?
D2?
D3?

A 
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
40
Q

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?

A

Insulinoma
Gastrinoma
Insulinoma

41
Q

What is the McVay repair anchoring?

A

anchoring the conjoint tendon to Coopers ligament thereby obliterating the femoral space.

42
Q

MoA of digoxin?

A

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.

43
Q

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?

A

4 days.

44
Q

Signs of propofol infusion syndrome?

A

cardiac failure, rhabdomyolysis, metabolic acidosis, and kidney failure, and is often fatal

Review Cards (21 decks)

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