Stupid crap I can never remember Flashcards
screening intervals for Barrett’s esophagus
what’s low risk? how often?
what’s high risk? how often?
how often for high risk with low grade dysplasia?
low risk: less than 3cm, no dysplasia. every 2 years
high risk: more than 3cm or circumferential. every year
high risk with low grade dysplasia: every 6 months
high risk, high grade: q3 months, EMR
flumanezil to treat what?
what is the dose? how much can you give?
to treat benzo toxicity
0.2mg IV loading dose over 30 seconds then up to 3mg
felon vs. paronychia
felon: infection of the fingertip pulp. needs midline incision. lateral incision can hurt nerve bundle
paronychia: infection of the skin fold around the nail bed. needs lateral incision
Merkel cell carcinoma:
CK-20? TTF-1?
sentinel node?
adjuvant radiation? chemo?
Merkel cell is CK-20 (+), TTF-1 (-)
small cell carcinoma of the lung is CK-20 (+), TTF-1 (+)
Yes. do sentinel node
yes radiation. no chemo
lentigo maligna vs. acral lentiginous melanoma
what is the most common non-skin melanoma?
leitgo maligna is usually in older patients. LEAST AGGRESSIVE melanoma. rare in dark skin ppl
Acral lentiginous: nails, toes. most common subtype in dark skin ppl
most common non-skin melanoma: eye melanoma
apocrine vs. eccrine gland
apocrine empties into hair follicles. blockage of this causes hidradenitis
eccrine empties into pores on the skin
borders of superficial inguinal node dissection?
location and significance of cloquet’s node?
borders of the deep inguinal lymphadenectomy?
5cm above the inguinal ligament superiorly
adductor longus medially
sartorius laterally
cloquet’s node is below the inguinal ligament and medial to femoral vein. if (+) then do a deep node dissection
bifurcation of the common iliac artery into the external and internal iliac arteries. The caudal limit is the inguinal ligament.
what primary tumor metastasizes to the skin the most?
breast goes to the skin most frequently
hidradenitis staging differences
Hurley I: multiple abscess, NO SINUS tracts. most patients present with this
Hurley II: recurrent abscesses with sinus tracts, multiple separated lesions
Hurley III: diffuse involvement. multiple connected sinuses
melanoma. (+) sentinel node but pt doesnt want node dissection. how do you surveil?
based on MSLT II okay to not do completion node dissection.
ultrasound of the nodal basin every 4 months for the first 2 years then every 6 months for the next 3 years
margin for squamous cell cancer
low risk: 4mm
high risk (tumor depth > 2mm, moderately differentiated, size > 2cm): 10mm
dermatofibrosarcoma protuberans. you do a margin negative WLE. are you done? what should you look for in pathology and do what if pathology shows this?
look for fibrosarcomatous changes in pathology. if this is present, then CT chest needs to be obtained
mechanism of resistance to beta-lactam antibiotics found in MRSA?
alteration of the antibiotic target site.
Methicillin resistance in MRSA is mediated by horizontal transfer of the mecA gene. This gene encodes penicillin-binding protein 2a, which has low affinity for beta-lactams, in contrast to the other types of penicillin-binding proteins. The low binding affinity of beta-lactams renders the antibiotic ineffective in its action at that target site
which immunosuppressant causes these side effects?
- GI bleed, pancytopenia
- Thrombocytopenia and poor wound healing
- GI bleed, pancytopenia: mycophenolate
mycophenolate also has 50% diarrhea incidence - Thrombocytopenia and poor wound healing: rapamune (sirolimus)
difference between
- physician assisted dying
- voluntary active euthanasia
- Passive euthanasia
- rule of double effect
- physician assisted dying: when a physician prescribes a lethal dose of a medication for a patient to administer himself
- voluntary active euthanasia: when a physician knowingly administers a lethal medication to a patient per his request to end his life
- passive euthanasia: withdrawal of care
- rule of double effect: palliative medication given specifically to alleviate symptoms and it foreseeably, though unintentionally, hastens a patient’s death
pts should quit smoking how many weeks before surgery?
what DLCO and FEV1 is needed to be able to undergo pneumonectomy?
4 weeks
DLCO > 60%, FEV1 > 60% for pneumonectomy
who needs a screening CT for lung cancer?
what to do with 8mm ground-glass opacity?
all patients aged 55 to 80 with at least a 30 pack-year smoking history who either currently smoke or have quit in the past 15 years
lesions <1cm can be followed with follow-up CT
risk of transmitting hep C from needle stick?
HIV?
- 8% for hep C
0. 3% for HIV
how does cetuximab work?
decreases production of EGFR by binding it on both normal and tumor cells. inhibits the binding of EGF and other ligands. it inhibits the phosphorylation of kinases
ipilimumab blocks what?
pembrolizumab blocks what?
nivolumab?
ipilimumab: CTLA-4
pembrolizumab (keytruda): PD1
nivolumab: PD1
screening for HNPCC
colonoscopies every 1-3 years starting age 20-25
annual transvaginal ultrasound starting 20-25
undescended testicle
- risk of testicular cancer compared to normal population?
- is the contralateral normal testicle also at risk for developing cancer?
- risk of cancer in undescended tesis in the abdomen vs. inguinal canal?
- most common type of cancer in testicle after orchiopexy vs. unrepaired undescended?
- does earlier orchiopexy reduce risk?
- about 2-8 times more
- contralateral testes is not at increased risk
- if in the abdomen, 4-5x higher risk than inguinal
- uncorrected undescended testis: seminoma
- after orchiopexy: non-seminoma
- yes, preadolescent repair results in decreased risk of cancer
most common tumor found in meckel??
carcinoid
hernia repair.
this nerve lies superiorly in the canal and passes through the external oblique aponeurosis superior to the external ring
this nerve travels beneath the inguinal ligament and does not enter the inguinal canal
this nerve runs within the spermatic cord and supplies the cremaster muscle
iliohypogastric nerve lies superiorly in the canal and passes through the external oblique aponeurosis superior to the external ring
femoral branch of the genitofemoral nerve travels beneath the inguinal ligament and does not enter the inguinal canal
genital branch of the genitofemoral nerve runs within the spermatic cord and supplies the cremaster muscle
what is Amyand hernia
what is Littre hernia
Amyand: Appendix
Littre: Meckel diverticulum
peds. gasless abdomen. procedure of choice?
what are the TE fistula types
gasless abdomen means long gap esophageal atresia. needs G-tube to let kid grow over time (type A or type B)
type A: atresia. no fistula type B: atresia. proximal fistula type C: atresia, distal fistula type D: both proximal and distal fistula type H: H
liver CT: enhancement of the lesion on arterial phase followed by washout on delayed phase
delayed washout is pathognomonic for HCC. Hepatic adenomas have a variable CT appearance that overlaps with that of HCC, because both lesions enhance on arterial phase. However, hepatic adenomas do not typically demonstrate delayed washout.
esophageal CA found on endoscopy. best way to assess locoregional disease? PET CT or MRI?
PET CT of the chest
should mesh be used for large hiatal hernia repairs?
short term outcomes are better but it doesn’t matter long term based on 3 different RCTs
normal esopahgus is lined by what type of epithelium?
normal stomach is lined by what epithelium?
stratified squamous epitheliu
stomach is lined by simple columnar epithelium
most common anterior mediastinum tumor?
middle?
posterior?
anterior: thymoma. myasthesnia gravis
middle: lymphoma
posterior: neurogenic tumors
pt with Zenker’s diverticulum has cervical stenosis and can’t extend neck. treatment option?
when is it okay to do myotomy alone vs. diverticulectomy?
can’t do endoscopy because can’t extend neck
straight up open diverticulectomy with myotomy
> 5cm definitely do diverticulectomy
<2cm myotomy alone may be sufficient