True Learn Flashcards
A _ involves radioactive tracers that emit gamma rays as they decay. The overall amount of ionizing radiation is less than other common diagnostic tests that might be used to evaluate epigastric pain and nausea/vomiting.
A nuclear medicine HIDA scan involves radioactive tracers that emit gamma rays as they decay. The overall amount of ionizing radiation is less than other common diagnostic tests that might be used to evaluate epigastric pain and nausea/vomiting.
The most common location for an ectopic inferior parathyroid gland
The most common location for a missed gland
The most common location for an ectopic inferior parathyroid gland is in the tail of the thymus and can migrate to the anterior mediastinum. The most common location for a missed gland is in the normal anatomical position.
Additional differential diagnosis for acute appendicitis, especially if appendix appears normal during exploratory surgery
Meckel diverticulitis should be considered as a differential diagnosis in a case of acute appendicitis. If the appendix appears normal during exploratory surgery, inspect the ileum for Meckel diverticulum or terminal ileitis (ie, Crohn disease).
Surgical cricothyroidotomy is performed by incising the trachea at the level of the _ membrane and passing a _ endotracheal tube to approximately _ cm.
Surgical cricothyroidotomy is performed by incising the trachea at the level of the cricothyroid membrane and passing a cuffed 5.0 to 7.0 mm endotracheal tube to approximately 5 cm.
No question
Outcomes in patients with intra-abdominal infections who have undergone a successful source-control procedure and receive a fixed, 4-day course of antimicrobial therapy appear to be generally similar to outcomes in patients in whom systemic antimicrobial agents are administered until after the resolution of signs and symptoms of sepsis.
Pancreatic secretion is about _ per day
Pancreatic secretion is about 500-1500 ml per day.
MEN 2A is characterized by _
MEN 2A is characterized by medullary thyroid cancer, pheochromocytoma, and hyperparathyroidism. Prophylactic thyroidectomy should be performed by age 5.
Considerations for open drainage of intraabdominal abscess _
Considerations for open drainage of intraabdominal abscess include no percutaneous accessibility, no source control (ongoing gastrointestinal spillage), interloop abscess, multiple abscesses, loculated abscess, communication with bowel, associated necrosis, unstable patient, and previously failed percutaneous drainage attempt.
Exocrine pancreatic insufficiency is _
Exocrine pancreatic insufficiency is the inability to properly digest food due to a lack of digestive enzymes made by the pancreas. It is found in humans afflicted with cystic fibrosis and chronic pancreatitis. It is caused by a progressive loss of the pancreatic cells that make digestive enzymes; loss of digestive enzymes leads to malabsorption of nutrients from normal digestive processes.
Risk factors for spontaneous pneumothorax include (6 answers)
Marfan syndrome, homocystinuria, thoracic endometriosis, family history, malnutrition, and smoking
Mechanism of negative pressure wound therapy
Promoting granulation tissue formation is the dominant mechanism by which negative pressure wound therapy assists the healing of wounds
Most common cause of mortality ~1 year after cardiac transplant
Sudden cardiac death occurs in 10-20% of post-cardiac transplant patients and is suspected to be due to graft vasculopathy
Full thickness skin graft technique
Full-thickness skin graft harvest sites are elliptical to allow for primary closure, are taken with a knife, and are primarily closed
Amsterdam criteria
•At least 3 relatives with lynch syndrome-associated cancer (colorectal, endometrium, small bowel, ureter, or renal pelvis)
•One should be a first degree relative of the other
•at least 2 successive generations
•familial adenomatous polyp osis should be excluded
Tumors should be verified by pathological examination
Crichothyroidotomy technique
Surgical crichothyroidotomy is performed by incising the trachea at the level of the crichothyroid membrane and passing a cuffed 5.0 to 7.0mm endotracheal tube to approximately 5cm
Anatomy of epididymis
Epididymis runs from the testis to the vas deferens
Spinal tuberculosis
Spinal tuberculosis may present as a chronic retroperitoneal abscess. Caseating granulomas are suggestive of tuberculosis
Number needed to treat equation
NNT=1/ARR (absolute risk reduction)
ARR=CER (control event rate) - EER (experimental event rate)
Classic Ehlers-Danlos
collagen affected
imaging study on diagnosis for screening
Classic Ehlers-Danlos syndrome is caused by defect in synthesis of type V collagen and leads to numerous issues resulting from deficient connective tissue including aortic root aneurysms. A CTA of the chest should be obtained.
Bonus points Autosomal dominant
Classic Ehlers-Danlos manifestations
-Skin hyperextensibility and velvety skin
-Significant joint hypermobility
-Significant tissue fragility
-Aortic root aneurysms
Autosomal dominant
Absolute contraindications to breast conserving surgery (BCS) include
Pregnancy
Diffuse malignant-appearing microcalcifications
Positive pathological margins
Wide-spread disease that involves more than one quadrant
Hepatic adenoma CT description
heterogenous mass with rapid enhancement during arterial phase
Focal nodular hyperplasia of liver CT description
Homogenous/isodense enhancement of a hypodense lesion with central scar
Hepatic hemangioma CT description
low density and peripheral nodular enhancement over time
2 major risks/complications of hepatic adenoma
- rupture - potentially life-threatening intraperitoneal hemorrhage
- malignant transformation, probably low risk
Strawberry hemangioma management
Strawberry hemangiomas appear at birth and are characterized by a rapid growth phase that then begins to involute. Observation is the standard of care because most hemangiomas resolve by age 7-8 unless they are complicated, and then they should be managed with medication, propranolol being the first-line therapy.
Layer incised for anterior component separation
External oblique
The external oblique aponeurosis is incised 1 cm lateral to the rectus sheath and is separated from the internal oblique aponeurosis. This allows the rectus sheath to slide medially as much as 10 cm from either side of the abdomen at the midportion of the abdominal wall.
Parkland formula
4mL x weight in kg x TBSA = amt for 24 hours
1st half given in first 8 hours
Rest given in following 16 hours
Energy requirement- surgical patient
Surgical patients - 25 kcal/kg/day and 1-1.5 g of protein/kg/day
Energy requirements- burn patients
Burn patients - 35-40 kcal/kg/day and 2-2.5 g of protein/kg/day
Energy requirements- trauma patients with and without sepsis
• Trauma patients with sepsis -30-35 kcal/kg/day and 1.5-2 of protein/kg/day
• Trauma patients without sepsis - 25-30 kcal/kg/day and 1.5 of protein/kg/day.
Side effects of common burn dressings-
Bacitracin
Nephrotoxicity
Side effects of common burn dressings-
Mafenide acetate (sulfamylon)
Metabolic acidosis
Side effects of common burn dressings-
Silver nitrate
Methemoglobinemia
Hyponatremia
Side effects of common burn dressings-
Silver sulfadiazene (silvadene)
Transient neutropenia
Vandetinib
Vandetanib is a tyrosine kinase inhibitor that has shown therapeutic efficacy in patients with metastatic or locally advanced medullary thyroid cancer.
Cartel-Braasch maneuver
Divide white line of Toldt and mobilize right colon medially.
Exposes right sided retroperitoneum
Tumor marker elevated in yolk sac tumors
AFP
McVay Repair
Can be used for inguinal and femoral hernias
Anchoring conjoint tendon to coopers ligament -> obliterating femoral space
Free water deficit equation
[(Serum Na -140)/140] x total body water
Women tend to have about 50% water and men ~60%. The % x Kg gives total body water
Most commonly mutated somatic gene in melanoma
BRAF
Most common is V600E mutation
Most common germline mutation in familial melanoma
CDKN2A
Fluoroquinolone MOA
Inhibit DNA gyrase
Ie ciprodloxacin
Small bowel daily secretions
1500-2000 mL
Average is 1500 and mostly from duodenum
Site of most calcium absorption in GI tract
In the normal gastrointestinal tract, absorption of calcium is most efficient in the duodenum and proximal jejunum, which contain the highest levels of vitamin D-dependent calcium-binding proteins.
What are the essential fatty acids
Linoleic and linolenic acids are the only essential fatty acids.
Important for-
•cell membrane synthesis
•inflammatory cascade.
Parathyroid hormone mech
Increases calcium by 3 mechanisms:
•stimulation of calcium reabsorption in the distal convoluted tubule
•stimulation of osteoclasts releases of calcium from bone mineral stores
•stimulation of the formation of calcitriol (vitamin D), which increases dietary absorption of calcium.
Warthin tumor
•Common tumor arising from salivary gland
•strong association with smoking
•10% bilateral and 10% multicentric
•have rare malignant potential
Excision margins for Marjolin ulcer
•1cm minimum wide local excision
•type fo SCC from chronic wounds or scars
MOA pembrolizumab and nivolumab
•MAb against programmed cell death protein 1 (PD-1)
•it’s a cell surface receptor on T lymphocytes
•causes disinhibition or tumor reactive T lymphocytes -> mount response against cancer cells
Associated injuries with posterior hip dislocation
•sciatic nerve injury
•described as flexed, shortened, internally rotated and adducted right lower hip
Injury associated with posterior knee dislocation
Popliteal artery injury
Injury associated with supracondylar humerus fracture
Brachial artery injury
Could lead to Volkmann’s ischemic contracture
Injury associated with distal radius fracture
Median nerve compression
Injury associated with anterior dislocation of shoulder
Axillary nerve compression
Normal cardiac index
2.5-4 L/min/m^2
Normal pulmonary capillary wedge pressure
4-12 mm Hg
Normal systemic vascular resistance
700-1600 dynes/sec/cm^-5
Normal pulmonary vascular resistance
20-130 dynes/sec/cm^-5
Definitive Treatment of UGI bleed caused by isolated gastric varices caused by splenic vein thrombosis
Splenectomy
The principal determinant of survival after resection of isolated metastasis to the adrenal gland
Disease free interval between initial cancer and metastasis
MOA of orlistat
•inhibits gastric and pancreatic lipase
•decreased triglyceride metabolism and decreased absorption of free fatty acids
•side effects- deficiencies in fat soluble vitamins and oily stools
Where is ADH made and stored
•ADH made in supraoptic nuclei of the hypothalamus
•stored in posterior pituitary
•released in response to elevated plasma osmolality
Internal mammary artery is a branch of
Subclavian artery
Commonly injured in clamshell thoracotomy
TEG interpretation
Elevated R time
Give FFP
Implies prolonged time to clot formation
TEG interpretation
Elevated K time
Give Cryiprecipitate
Problem with fibrinogen
TEG interpretation
Elevated alpha angle
Give Cryoprecipitate
Problem with fibrinogen
TEG interpretation
Elevated MA
Give platelets and/or desmopressin
Problem with platelets
TEG interpretation
Elevated Ly30
Give TXA and/or aminocaproic acid
Problem is excess fibrinolysis
Anatomic point of construction that represents the narrowest point of esophagus
Cricopharyngeus muscle
CPP equations
The cerebral perfusion pressure (CPP)
CPP = (MAP) - (ICP).
In adults with TBI, it is recommended to maintain the CPP between 60 and 70 mm Hg.
Pyrogenic cytokines
IL-1, IL-6, and TNF-α
are proinflammatory cytokines that are pyrogenic. They are also known as endogenous pyrogens and are the key molecules involved in developing a fever.
