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zABSITE 2019 - high yield comprehensive > TRUE LEARN - ABSITE 2019 > Flashcards

TRUE LEARN - ABSITE 2019 Flashcards

1
Q

Child’s Pugh Score

A

Billirubin, Albumin, INR, Ascites, Encephalopathy

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2
Q

Criteria for transanal excision of adenocar

A

T0 or T1 (submucosa)

< 3 cm

< 30% circumference

Palpable on DRE (<8cm from anal verge)

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3
Q

Tx for gallstone ileus

A

Stable and healthy- stone removal and take down fistula

Unstable- stone removal only!

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4
Q

Tx of cholangiocarcinoma

A
  1. Upper 3rd- duct resection w/ partial hepatectomy
  2. Middle 3rd- bile duct resection + LADN
  3. Lower 3rd- Whipple

*Locally advanced/unresectable- transplant

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5
Q

Orientation of portal triad

A

Bile duct lateral

Hepatic artery medial

Portal vein posterior

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6
Q

Secretin vs. CCK

A

Both released by duo

Secretin- duct cells –> bicarb

CCK- acinar cells –> enzymes

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7
Q

CCK

A

Release from duo (I cells)

Fxn: GB and Pancreatic contraction.

Gastric relaxation

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8
Q

Replaced R/ and L hepatic

A

R- SMA

L- left gastric

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9
Q

s/e of silver nitrate, silver sulfadiazene, mafenide

A

Silver nitrate- eletrolytes disturbace (no sulfa)

Silver sulfadizene- neutropenia, sulfa

Mafenide- met acidosis, sulfa

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10
Q

Parkland formula

A

4 x weight x TBSA 1st 1/2 in 1st 8h

2nd half next 16

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11
Q

Rule of 9s

A

Each arm 9

Each leg 18

Ant belly 9, Post belly 9

Each hand 1

Ant face 4.5, Post face 4.5

Genitals 1

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12
Q

Cholangiocarcinoma types

A

1- below confluence

2- at confluence

3- R or L hep duct

4- R and L hep duct

5- multicentric

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13
Q

Inidications for neoadjuvant chemotherapy for rectal cancer

A

Stage 2 and above

Stage 2: at least t3 (crossing musc prop) or any n (stage 3)

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14
Q

Layers of colon/rectum

A
  1. mucosa
  2. sub-mucosa
  3. muscularis propria
  4. serosa
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15
Q

HNPCC inheritance

A

AD

Defect in MLH/MSH

Bethesda criteria:

  1. 3x1d relative
  2. 2xgenerations
  3. 1x<50y
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16
Q

Most abundant bacteria in the colon

A

Bacteroides fragiles

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17
Q

CRC staging

A

stage 1- t1 to t2, n0

stage 2- t3 to t4, n0

stage 3- node involvement

stage 4- m1

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18
Q

CRC T and N

A

t1- SM

t2- MP

t3- xMP/subserosa

t4- invade

n1- 1-3, n2- >=4

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19
Q

Peutz-Jeghers

A

AD

Px- intestinal hamartomas, pigmented oral mucosa

Start screening at 25; scope q2 years

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20
Q

Fuel for colonocytes

A

SCFA (acetate, butyrate, propionate)

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21
Q

Insulinoma

A

Loc: throughout

Px: whipple’s triad

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22
Q

Glucagonoma

A

Loc: distal

Px: dermatitis, DRH, DM, nec mig erythema

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23
Q

VIPoma

A

Loc: distal

Px: watery DRH, hypoK, achlorhydria, inhibits gastrin

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24
Q

Gastrinoma

A

Loc: gastrinoma triangle (CBD, panic neck, 3D)

Px: refractory PUD, gastrin > 200 on sec stim test

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25
Q

Somatostatinoma

A

Loc: head

Px: DM, gallstones, steatorrhea, block exo/endo pancreas

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26
Q

VHL

A

up regulation of vegf

hyper vascular tumors

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27
Q

Li Fraumeni

A

p53 mutation

breast ca + soft tissue sarcoma

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28
Q

Cowden’s

A

pten mutation

breast ca + thyroid ca + hamartomas

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29
Q

Tx of Zenkers

A

<2cm: circopharyngeal myotomy

2-5 cm: myotomy +/- diverticulectomy

>5cm: myotomy + diverticulectomy

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30
Q

Traction vs. Pulsion Diverticulum

A

traction- inflammation; all 3 layers; mid eso

pulsion- pressure; 2 layers; above circoph.

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31
Q

Tx of Barrett’s

A

low grade dysplasia: repeat scope/bx in 6m

high grade dysplasia: endoscopic mucosal resection

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32
Q

Types of esophogectomy

A

Transhiatal- laparotomy and cervical incision/anast

Ivor Lewis- thoracic incisions/anast

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33
Q

Achalasia

A

high LES pressure

incomplete relaxation

no peristalsis

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34
Q

DES

A

normal LES pressure

normal relaxation

unorganized peristalisis

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35
Q

Nutcracker eso

A

high amplitude/long peristalsis

normal LES pressure

normal relaxation

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36
Q

Hormones that increase LES pressure

A

Gastrin

Motilin

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37
Q

Superior laryngeal nerve

A

motor to cricothyroid injury: high pitch

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38
Q

Recurrent laryngeal nerve

A

motor to larynx excluding circothryoid injury: hoarsness, airway compromise

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39
Q

Free water deficit

A

TBW x [(Na-140)/140]

TBW = weight x .6 (men) or .5 (women)

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40
Q

Tx for hyponatermia

A

Acute sxatic: hypertonic saline

Hypervolemia: hypertonic saline

Euvolemic and asxatic: free water restriction

Hypovolemic: volume resuscitate w/ LR or NS

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41
Q

Tx of SIADH

A

fluid restriction

demeclocycline

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42
Q

Calcitonin

A

Parafollicular C cells Inhibits osteoclast resorption

Increases Ph excretion

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43
Q

Succinylcholine

A

MOA: depolarizing muscle relaxant

rapid on and off (RSI)

s/e- hyperkalemia, can’t reverse, peaked t waves

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44
Q

Loop diuretics vs. Ca sparing diuretics

A

loop- furosemide

Ca sparing- thiazides

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45
Q

421 rule for mIVF

A

4 ml/kg/hr for 1st 10 kg

+2 for next 10-20

+1 for every kg above 20

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46
Q

Hypocalcemia

A

tingling

chvostek/trousseau sign

EKG- qt prolongation and TWI

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47
Q

T staging for esophageal cancer

A

t1a- muscularis mucosa

t1b- SM

t2- muscularis propria

t3- adventitia

*no serosa

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48
Q

Hypokalemia EKG

A

prolonged PR, TWI, qt prolongation

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49
Q

Hyperkalemia EKG

A

prolonged QRS, peaked T wave

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50
Q

Torsades

A

2/2 hypoK, hypoCa, hypoMg

all cause qt prolongation

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51
Q

Markers:

Cancer Ca 125

bHCG

AFP

Inhibin

A

Ca 125- epithelial

bHCG- choriocarcinoma

AFP- germ cell/endodermal/yolk sac

Inhibin- granulosa/sex-cord

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52
Q

Cervical neoplasia

A

CIN1- tx infection, close f/up

CIN2- cryo or leep

CIN3- cryo or leep

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53
Q

McVay repair

A

Hernia repair without mesh

Approximates TAA to cooper’s ligament

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54
Q

Spigelian hernia

A

found along semilunar line lateral to rectus

all should be repaired

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55
Q

Richter’s hernia

A

protrusion and/or strangulation of part of the intestine’s anti-mesenteric border

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56
Q

Octreotide

A

Somatostatin analogue

Inhibits exocrine function of pancreas and CCK release

Tx for chronic pancreatitis

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57
Q

long chain vs. medium chain TG

A

LC- absorbed by lymphatics

MC- absorbed into blood

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58
Q

Pseudocyst

A

encapsulated

lack epithelial lining

>5cm requires drainage

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59
Q

Pancreas drainage procedures

A

Peustow- pancreaticojej (for large duct)

Frey- pancreasticojej + core out head

Berger- pancreatic head resection (for large head)

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60
Q

Atlanta classification pancreatits

A
  1. Interstitial:
  • <4w- acute peripanc collection,
  • >4w psuedocys

t2. Necrotic:

  • <4w- acute necrotic collection
  • >4w- walled of necrosis
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61
Q

Tx of psuedocyst

A

<6cm and <6w –> conservative

>6cm and >6w –> drain if sxatic (perc cath, endoscopic methods, or surgery)

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62
Q

Pancreatic ducts

A

Wirsung- major, lies inferior

Santorini- minor, lies superior

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63
Q

Hereditary pancreatitis

A

PRSS1 trypsinogen mut’n

AD

smoking cessation is important

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64
Q

Ranson’s criteria on admission

A

“GA Law”

age > 55

Glu > 200
LDH > 350

AST > 250

WBC > 16

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65
Q

Ranson’s criteria at 48 h

A

“C and Hobbs”

Ca < 8

HCT down > 10 pts

O2 < 60

Base deficit > 4

BUN > 5

Sequestration of fluids > 6L

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66
Q

Blood supply of pancreas

A

Head: superior PD and inferior PD

Body/tail: splenic

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67
Q

MOA reglan and erythromcyin

A

reglan: dopamine antagonist
erythromycin: motlin receptor agonist causing SM contraction

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68
Q

Indications for neoadjuvant therapy for stomach cancer

A

Any T2 lesion or LN involvement

T2: growth into the muscularis propria

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69
Q

T staging for gastric cancer

A

t1- SM

t2- MP

t3- xMP/subserosa

t4- invade

n1: 1-2, n2: 3-6, n3: >7

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70
Q

Number of LN needed for gastric vs. CRC

A

gastric- 15 CRC- 12

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71
Q

Somatostatin

A

D cells in stomach, duo and panc

Shuts off insulin, glucagon, and gastrin

Stimulated by acid

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72
Q

Marginal ulcer vs. Cameron ulcer

A

Marginal- REYGB at GJ anastomosis

Cameron- on lesser curve of large hiatal hernia

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73
Q

Triple therapy

A

PP1 + 2 antibiotics abxs: amoxicillin, metronidazole, tetracycline, clarithromycin

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74
Q

Loss in excess weight for each surgery

A

REYGB- 75%

SG- 60%

Lap band- 50%

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75
Q

Gastrin

A

G cells of antrum signal EC cells –> His –> Parietal cell –> HCl

Stimulated by ACh, beta ago, AA

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76
Q

Types of vagotomy

A

Highly selective: only removes innervation to lesser curvature

  • preserves pylorus → no drainage procedure

Truncal vagotomy: removes lesser curve and pylorus nerves (upstream)

  • need pyloroplasty. high r/o dumping syndrome
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77
Q

location of vagus nerve

A

LARP left anterior, right posterior to esophagus

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78
Q

Tx of GIST

A

Resection w/ gross margin

No LN dissection

Add imatinib (TK inhibitor) if >5m/50HPF

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79
Q

Fuel for SB and LB

A

SB- glutamine

LB- SCFA

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80
Q

Specific to Crohn’s disease

A

Cobblestoning

Granulomas

Transmural Fistulas

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81
Q

Kaposi’s sarcoma

A

HSV8

Violet/brown papules

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82
Q

ITP

A

Cause: autoab to PLTS

Tx: steroids –> splenectomy (avoid PLTs)

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83
Q

Who needs stress dose steroids

A

>20 mg of steroids for > 3 weeks

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84
Q

Encapsulate organisms

A

Strep pneumo (MC)

Neisseria

Haemophilus

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85
Q

Carcinoid vs. GIST origin and tx

A
  1. carcinoid- Kulchinsky cells (enterochromaffin-like)
    • < 2cm –> appendectomy
    • > 2cm –> R hemi
    • chemo if unresectable
  2. GIST- cajal cells
    • tx- resection
    • imantinib
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86
Q

Localization studies pheo, aldo, gastronoma, PT

A

pheo- i131

aldo- adrenal vein sampling

gastrinoma- SS receptor

PT- sestamini

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87
Q

Order of potency of steroids

A
  1. HC
  2. Pred
  3. Methylpred
  4. Dexameth
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88
Q

Products of anterior pituitary

A

TSH, ACTH, FSH/LH, GH, Pro

neurosecretory cell stimulates hypothalamus which lets go of releasing hormone

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89
Q

Products of posterior pituitary

A

“PAO in the POST”

ADH, Oxytocin

2/2 direct stem from neurosecretory cell

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90
Q

When to operate on adrenal mass

A

all functioning tumors

all > 6 cm –> open resection (no lap)

if < 6cm with suspicious features (>10HU, slow w/out) –> open resection (no lap)

if bilateral –> tx medically w/spironolactone

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91
Q

Imaging associated with benign adrenal mass

A

< 10HU

Rapid washout

< 4cm

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92
Q

Bethesda criteria for thyroid

A

10 mm is cutoff to get an FNA

  1. Non-diagnostic → repeat FNA
  2. Benign → follow-up
  3. Undetermined significance → repeat FNA
  4. Suspicious for follicular neoplasm → lobectomy, repeat FNA, or genetic testing (no core needle)
  5. Suspicious for malignancy → lobectomy vs. thyroidectomy
  6. Malignant → thyroidectomy
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93
Q

Staging adrenal cancer

A

s1- <5cm

s2- >5cm

s3- n1 or t3

s4- mets

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94
Q

Origin of med thyroid cancer

A

4th pharyngeal arch NCC –> parafollicular C cells

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95
Q

Indications for radioiodine thereapy

A

2-4 cm mass

vascular invasion

anti-Tg Ab

TG < 5

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96
Q

What is not suppressed by high dose dexa

A

Adrenal mass

Ectopic mass (small cell cancer)

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97
Q

Sub-acute thyroiditis

A

Recent viral URI

tx- NSAIDs/steroids

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98
Q

Hot vs. cold nodules

A

Hot- surgery or iodine ablation –> unlikely cancer

Cold- FNA –> may be cancer

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99
Q

Drainage of gonadal veins

A

R- IVF

L- L renal vein

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100
Q

MCCO cauti

A
  1. e. coli
  2. enterococcus
  3. candida
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101
Q

Tx of renal cell carcinoma

A

resistant to chemo/rads

1st line is TK inhibitors (sunitinib)

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102
Q

Ureter injuries

A

proximal ⅓ → primary ureterourostomy

middle ⅓ → primary or tran uretero urosotomy

lower ⅓ → re-implanation +/- hitch

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103
Q

tacro

A

MOA: calcineurin inhibitor (binds fK)

s/e- nephrotoxic

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104
Q

cyclosporine

A

MOA: calcineurin inhibitor

s/e- 100x less potent then tacro, nephrotoxic

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105
Q

MMF

A

MOA: cell cycle inhibitor

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106
Q

basiliximab

A

MOA: IL2 inhibitor

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107
Q

sirolimus

A

MOA: mTOR inhibitor

s/e- lymphocele, wound complications

benefit- less nephrotoxic

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108
Q

Types of rejection

A

hyperacute- preformed IgG against donor; t2HS

acute- T and B cell resposne to MHC; t4HS

graft vs. host- graft T-cells attach host; t4HS

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109
Q

FRC

A

Volume of the lung after normal tidal expiration

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110
Q

Order of contents in thoracic outlet

A

vein (SC)

muscle (scalene)

artery (SC)

nerve (br plexus)

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111
Q

Acute cellular rejection

A

T cell mediated

path: portal cellular infiltrate + endotheliitis
tx: pulse steroids → consider thymo

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112
Q

Milan criteria

A

indications for trx w/ HCC

  1. Single tumor < 5cm
  2. No more than 3 tumors each < 3 cm

5-year transplant pt survival is 65-90%

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113
Q

hypovolemic shock

A

low CI, high SVR, low wedge

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114
Q

septic shock

A

high CI, low SVR, +/- wedge

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115
Q

cardiogenic

A

low CI, high SVR, high wedge

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116
Q

neurogenic shock

A

high CI, low SVR, low wedge

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117
Q

Grading of splenic injury

A

1- <1 cm,

2- 1-5 cm,

3- > 5cm,

4- segment/hilar vessels,

5- shattered

Return to activity → injury grade + 2; so grade 2 would be 4 weeks

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118
Q

Post splenectomy ppx

A

“SHiN”

PPV23 + haemophilus influenzae TYPE B + meningococcal polysaccharide

Electively- 2 weeks before

Emergently- PPV23 directly postop, other two given 2 w post op

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119
Q

GCS eye opening

A

4- spon

3- to voice

2- to pain

1- none

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120
Q

GCS verbal

A

5- normal

4- confused

3- inappropriate words

2- incomprehensible

1- none

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121
Q

GCS motor

A

6- obeys commands

5- localized

4- w/draws

3- flexion (decort)

2- extension (decerebrate)

1- none

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122
Q

Zone injuries

A

penetrating:

  • zone 1-3 –> explore

blunt:

  • zone1 –> explore
  • zone 2-3 –> do not explore
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123
Q

Mattox maneuver

A

“L –> Mattox”

move left structures to the right

exposure left sided vasculatre

explore aorta and L renal vein

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124
Q

Hard signs of vascular injury

A

shock

expanding hematoma

pulsatile bleed

thrill/bruit

absent pulse

ischemia

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125
Q

TASC classifcation

A

TASC a and b usually get endovascular repair

A- < 3cm

B- 3-10 cm

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126
Q

Rule of 6s

A

flow > 600/min

diameter > 6mm (after placement)

depth of 6mm

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127
Q

Indications to tx ICA stenosis

A

if Asx, only tx if > 60

if sx, tx if > 50

sxs- contralateral motor/sensory sxs, ipsi vision sxs

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128
Q

Central cord syndrome

A

loss of pain, temp, motor

motor UE> LE loss (vs. anterior syndrome)

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129
Q

MC aortic infections

A

aneurysmal- staph

non-aneurysm- salmonella

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130
Q

Paget Von Schroetter syndrome

A

narrowing of SC/Ax vein 2/2 mech compression

px- acute swelling

Tx- catheter directed thrombolysis (NOT open thrombectomy)

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131
Q

Indications for iHD

A

GFR 10-15 for sxatic

GFR < 5 for asymptomatic

Sxs = AEIOU (acid, lytes, intox, olverload, uremia)

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132
Q

c/i to BCT

A

multicentric

inflammatory ca

c/i to radiation

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133
Q

Modified radical mastectomy

A

mastectomy with ALND (level 1 and 2 only) w/ sparing of pectoralis

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134
Q

Gail model

A

age

age 1st period

age 1st birth

1d relative

previous bx

race

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135
Q

Tx of breast CA in preg

A

partial mastectomy + radiation after preg OR full mastectomy

trastuzumab is c/i

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136
Q

Mondor disease

A

tender, “cord-like” structure

tx- NSAIDs

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137
Q

Stage 3 breast CA

A

3a: 4-9 LNs
3b: t4 disease (extension beyond breast)
3c: 10+ LNs

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138
Q

Indications for neo-adjuvant therapy for breast CA

A

stage3+ or inflammatory breast

  • CA 3a: 4-9 LNs
  • 3b: t4 disease (extension beyond breast)
  • 3c: 10+ LNs
139
Q

long thoracic nerve vs. thoracodorsal nerve

A

LTN → serratus –> winged scap

TD → LD –> difficult shoulder ADduction/Int rotation

140
Q

Screening guidelines for breast ca

A

annual screening at age 40

141
Q

Phyllodes tumor

A

“sarcoma of the breast”

tx- en bloc resection

hematog spread- chemo/LN dissection unnneccesary

142
Q

Benign lesions that require excisional bx

A
  • Atypical DH
  • Atypical LH
  • LCIS
  • radial scar
  • papillary lesion
  • any atypia
143
Q

Intraductal papilloma

A

MCCO bloody nipple d/c

tx w/ duct excision

no increased r/o ca

144
Q

Fibroadenoma

A

cyclical pain

dx- US guided core bx

only excise if discordance with biopsy!

145
Q

Stewart-Treves syndrome

A

post mastectomy lymphangiosarcoma

rare and highly malignant

Tx- wide local excision w/ 3-6 cm margin

146
Q

Tx preg with hormone positive breast CA

A

part mastectomy, SLNBx w/ radio tracer (not meth blue)

RTx after birth

147
Q

TRAM flap

A

SUPERIOR epigastric artery can use ipsi or contra muscle

148
Q

Normal values: CVP, WP, SVR, CI

A

CVP 2-6

WP 4-12

SVR 700-1500

CI 2.5-4

149
Q

TLV

A

TLV = RV + ERV + TV + IRV

FRC = RV + ERV

IC = TV + IRV

150
Q

ARDS ratio

A

P/F

  • mild- 200 to 300
  • moderate 100-200
  • severe < 100
151
Q

Arterial content

A

(1.34 x Hb x Sa02) + (.003 x PaO2)

152
Q

Milrinone

A

PD inhibitor

contractility with vasodilation

great for pulmonary hypertension

153
Q

Midodrine

A

a1 agonist

154
Q

Dopamine dosing

A

low- d1/2 ago (renal dose)

medium- B ago

high- A ago

155
Q

MC uni-microbial CO nec fasc

A

Clostridium perfringens

gas gangrene

anaerobic

156
Q

Human bite tx

A

amox/clavulanate

MC for human bites- eikenella

157
Q

MCCO healthcare infection:

  • HAP
  • central line infection
  • SSI
  • UTI
  • GI infection
A
  • HAP: staph
  • central line infection- candida
  • SSI- staph
  • UTI- e. Coli
  • GI infection- c. diff
158
Q

MRSA tx

A

vancomycin

if vanc resistant then linezolid

159
Q

Echinococcal cyst

A

hydatid disease

multiple small cysts w/in big one

Tx- total/partial splenectomy. can sterilize w/ EtOH injxn; spillage causes anaphylaxis (do not drain)

160
Q

Staph epi

A

exo slime/biofilm from PIA capsule

blocks abx effect

161
Q

Group A strep

A

strep pyogenes

suspect if gas and bullae

162
Q

LIPID A

A

Gram negative bacteria (Klebsiella) have outer lipopolysaccharide layer with LIPID A endotoxin → septic shock

163
Q

PEAK and TROUGH

A

PEAK- amount

TROUGH- frequency

164
Q

Primary lymphoid organ vs. secondary

A

Primary: generate cells i.e. liver, bone, thymus

Secondary: maintain cells i.e. nodes, spleen, MALT

165
Q

TNFa

A

produced by macrophages

166
Q

Lipopolysaccharide

A

cell wall of GN bacteria endotoxin

activates complements cascade → sepsis

167
Q

Wound healing order of entry

A

plts → PMNs → macrophages → fibroblast → keratinocytes

168
Q

Fibrolamellar HCC

A

well circumscribed w/ central scar similar to FNH

normal AFP and elevated neurotensin (Vs. FNH)

169
Q

hepatic adenoma

A

path- EARLY HETEROGENEOUS enhancement on A phase w/ rapid washout

tx- stop OCP use. resect if > 5cm or sxatic

170
Q

FNH

A

path- CENTRAL STELLATE SCAR!; bright on arterial phase homogenous

tx- resect if sxatic. no malignant potential.

171
Q

bile salt circulation

A
  1. conjugate in hepatocytes into gly/taurine
  2. secreted into bile
  3. 80% reabsorbed in ileuim ACTIVELY
  4. 20% DECONJUGATED by bacteria
  5. deconjugated salts absorbed in colon PASSIVELY
    1. 5% is excreted
172
Q

Hemangioma

A

path- PERIPHERAL ENHANCEMENT

tx- if rupture, size change, or KM syndrome

173
Q

Kasabach-Merritt Syndrome:

A

hemangioma + thrombocytopenia

usually infants

resect!

174
Q

Entamoeba histo

A

MExico

tx with MEtronidazole (no OR!)

NO rim enhancement (vs. amoebic abscess)

dx- EIA (assay)

175
Q

Echinoccocus

A

Hydatid cyst

tx w/ mebendazole

176
Q

Pyogenic abscess

A

e. Coli and kleb

tx- perc drainage is 1st line!

177
Q

MCCO of spontaneous bacterial peritonitis

A

E. Coli

178
Q

Hepatitis seromarkers

A

Vaccinated: surface Ab POSITIVE

Resolved Hb infection: surface Ab POSITIVE and core Ab POSITIVE

Active infection: surface Ag, surface Ab, and core Ab ALL POSITIVE

179
Q

Liver lesions on arterial phase:

  • HCC
  • Mets
  • Adenoma
  • Hemangioma
  • FNH
A
  • HCC- Homogeneous enhancement
  • Mets- Hypoattenuation
  • Adenoma- Heterogeneous enhancement
  • Hemangioma- Periph enhancing
  • FNH- Centrifugal enhancing
180
Q

Mucoepidermoid carcinoma

A

MC malignant H/N tumor

181
Q

Pleomorphic adenoma

A

MC benign H/N tumor

middle aged woman

slow growing; t2 bright

Tx: superficial parotidectomy even if asx

182
Q

Adenoid cystic carcinoma

A

MC minor salivary gland tumor (SM gland)

propensity for perineural invasion

Remains quiescent for years then metastasizes aggressively

183
Q

Warthin tumor/Papillary cystadenoma

A

benign tumor of salivary gland

often BILATERAL and 2/2 smoking

Tx- complete resection with uninvolved margins even if ASx

184
Q

CN11

A

spinal accessory nerve

exit jugulars foramen

innervates SCM and trapezius goes along post triangle

185
Q

Contents of post triangle

A

CN 11 subclavian artery

EJV

brachial plexus trunks

186
Q

Contents of ant triangle

A

carotid sheath, anca cervicalis, CN 12

Contents of carotid sheath: CN10 (vagus), CCA, ICA

187
Q

Frey syndrome

A

gustatory sweating s/p parotidectomy

188
Q

Felty syndrome

A

rheumatoid arthritis, splenomegaly, granulocytopenia

189
Q

LeFort fxs

A

I- palate

II- nose and palate

III- entire face

190
Q

Pyoderma gangrenosum

A

associated w/ IBD

RESOLVES after resection

pre-tibial

tx- steroids

191
Q

Merkel cell ca

A

rare neuroendocrine tumor of the skin

looks like BCC w/out rolled edges

highly radiosensitive

Tx- surgical excision + SLNBx + XRT

192
Q

SLNBx for melanoma

A

< .75 mm none

> .75 to 1 mm w/ ulceration, mitosis, invasion

193
Q

Stage 1 melanoma

A

1A: .76-1mm w/ no ulceration, no mitosis

1B: mitosis, invasion, ulceration

194
Q

Breslow depth

A

t1: < 1mm → .5-1 cm margin
t2: 1-2 mm → 1-2 cm margin
t3: > 2 mm → 2 cm margin

195
Q

Vitamin C

A

hydroxylation of lysine and proline

type 3 collagen cross-linking

196
Q

Gardner’s Syndrome

A

AD

polyposis, osteomas, multiple epidermal cysts

197
Q

Minimum negative margin for BCC

A

4 mm for unaggressive

8 mm for aggressive tumors

198
Q

Melanoma types

A

superficial spreading- MC

lentigo- sun exposed, best prog

nodular- worst prog

199
Q

MS vs. ED

A

MS- Fibrillin defect (elastin); AD, tall, aortic root dilation, lens defect, arachnodactyly

ED- t1, t3 , t5 collagen defect; hyper elastic skin, hypermobile joints

200
Q

ASA

A

irreversible inhibitor of PG metabolism in PLTs

2/2 cox acetylation

7-days of PLT dysfunction

201
Q

VW disease

A

1- low quantity. tx- desmo and cryo

2- low quality: tx- only cryo

3- complete absence: tx- cryo and desmo dx- ristocetin test or measure vWF level

202
Q

Heparin

A

accelerates AT3 activity and INDIRECTLY inhibits thrombin

203
Q

Mechanical valve periop

A

restart coumadin in 12-24h and bridge w/ heparin or lovenox

204
Q

ITP

A

px- petechiae and megakaryotcytes

tx- steroids (IVIG 2nd line)

  • do not tx unless PLT < 30k or 20k in low risk
205
Q

TTP

A

path- def in ADAMtS13

px- TCP purpura, neuro sx, kidney dz, hemo anemia, fever

tx- plasmapheresis → splenectomy if failed

206
Q

F11 def

A

r/o bleeding w/ surgery

tx- FFP (not f11 concentrate!)

207
Q

Rapid coumadin reversal

A

PCC

208
Q

VWF

A

binds GP1b on PLTs and attaches them to endothelium

209
Q

PLTs

A

release txa2 → PLT aggregation

210
Q

TXA2

A

vasoconstrictors

released by PLTs

211
Q

Fibrinogen

A

binds gp2b/3a receptors to link PLTs together

212
Q

Thrombin

A

converts fibrinogen to fibrin

213
Q

Epoteitn

A

stimulated by HYPOXIA produced by kidney fibroblasts

Liver is major producer of EPO in fetus

214
Q

Hemophilia A

A

f8 DEFICIENCY SLR

MC inherited disorder

tx- DESMOPRESSIN (mild), f8 concentrate (severe)

215
Q

F5 Leiden

A

resistance to protein C and S

acts w/ Xa to converts fibrinogen to fibrin

216
Q

Felty Syndrome

A

RA + neutropenia + splenomegaly

217
Q

Wiskott-Aldrich Syndrome

A

X-linked

TCPenia + combined b/t cell def + eczema

218
Q

AT3 def

A

AD

non-vit K dependent protease for 10a potentiated by heparin

tx- FFP

219
Q

febrile transfusion rxn

A

RECIPIENTS Ab attack DONOR leukocytes

220
Q

Plasmin

A

degrades fibrin and fibrinogen

activated by urokinase and streptokinase

221
Q

Uremic PLT dysfunction

A

2/2 renal disease

reversible dysfunction

tx- desmopressin, cryo, conj estrogen, EPO, or blood DO NOT give PLTs

222
Q

MALT lymphoma

A

associated w/ h. Pylori. Tx:

  • Low grade: triple therapy
  • High grade: chemo and XRT (CHOP) +/- rituximab
223
Q

Interleukins 1, 2, 4

A

IL1: fever

IL2: T cell prolif and Ig production

IL4: T/B cell maturation

224
Q

Sarcoma T and N staging

A

T1- <5 cm

T2- > 5cm

N1- regional nodes

225
Q

Ovarian tumor markers:

AFP

CEA

HCG

LDH

Ca 125

Inhibin

A

AFP: yolk sac tumor, endodermal sinus

CEA: mucinous ovarian tumor

HCG: ovarian choriocarcinoma, embryonal carcinoma

LDH: dysgerminoma

Ca 125: epithelial ovarian tumors

Inhibin: granulosa cell tumor

226
Q

EBV associated with

A

Burkitt lymphoma

B cell lymphoma

n/ph cancer

227
Q

Imatinib

A

competitive inhibitor of TK

tx for GIST

228
Q

T staging for HCC

A

T1: any size without vascular invasion

T2: < 5 cm with vascular invasion

T3: > 5 cm with vascular invasion

T4: invade adjacent organs

229
Q

Origins of medullary thyroid cancer

A

4th pharyngeal arch releases NCC which form parafollicular C cells

230
Q

Indications for post op radio-iodine

A

2-4 cm

vascular invasion

anti-Tg Ab

TG<5

231
Q

hot vs cold nodules

A

hot- surgery or iodine ablation

cold- FNA

232
Q

neoadjuvant tx for RCC

A

TK inhibitors are 1st line (sunitinib)

Resistant to chemo/rads

233
Q

MOA of tacro, cyclosporine, sirolimus, mmf, basiliximab

A

tacro- calcineurin inhibitor

cyclosporine- calcineurin inhibitor

sirolimus- mTor inhibitor

mmf- cell cycle inhibitor

basilixamab- il2 inhibitor

234
Q

TOF anomalies

A
  1. Over-riding aorta
  2. RV hypertrophy
  3. VSD
  4. RV obstruction
235
Q

Beckwith Wiedmann Syndrome

A

3m-2y Associated with hepatoblastoma and wilm’s tumor

236
Q

5Ts of cyanosis

A
  1. TOF
  2. Transposition of GVs
  3. Truncus art
  4. Tricuspid atresia
  5. TAPVC
237
Q

type 1 choledochocal cyst

A

fusiform dilation tx- excision w/ REY H-J

238
Q

type 2 choledochocal cyst

A

cystic diverticula

tx- excision w/ primary closure (NOT a REY)

239
Q

type 3 choledochocal cyst

A

choledochocele

tx- transduodenal marsupialization or excision

240
Q

type 4 choledochocal cyst

A

extra/intra dilations

tx- excision w/ REH H-J

241
Q

Gastroschisis

A

GastRoschisis to the Right of midline rare defects

EXCEPTION- instestinal atresia

242
Q

Omphalocele

A

2/2 failure of umbo ring closure 11th week gut returns to abdominal cavity

normal bowel (protected)

Other congenital defect are more common

243
Q

Non-cyanotic heart defects

A

ASD

VSD

coarctation

244
Q

Thoracic duct course

A

originates at L1-L2 @ c. chyli → aortic hiatus → cross from R to L at T4-5 → empties into L SC/IJ jxn

245
Q

PFTs for lung resection

A

FEV1 > .8L

DLCO > 40%

FVC > 1.5L

VO2 > 10 ml/min/kg

246
Q

Mediastinal tumors

A

Anterior: lymphoma MC in children, thymoma MC in adults

Middle: lymphoma MC

Posterior: neurologic MC

247
Q

Cutoff for low risk lung nodules not requiring follow-up

A

6mm

248
Q

Number of lung segments

A

R-10

L-8

249
Q

Lung fissures

A

Oblique fissure: aka major fissure; separates upper lobe from lower lobe +/- middle

Horizontal fissure: aka minor fissure; only on the R; separates upper lobe from middle lobe

250
Q

Accessible nodal stations w/ EBUS

A

2, 3, 4, 7, 10, 11, 12

251
Q

Thyroid ima

A

supplies medial aspect of both lobes of the thyroid come off the innominate/brachiocephalic

252
Q

Cisatracurium

A

non-depolarizing

cleared by Hoffman degradation

use in pts w/ renal and hepatic disease

253
Q

Vecuronium

A

non-depol

eliminated by kidney and liver

254
Q

Pancuronium

A

non-depol

eliminated by kidney and liver

255
Q

Rocuronium

A

non-depol

rapid onset; best for short procedures

eliminated by liver only

256
Q

Succinylcholine

A

ONLY depolarizing

short half life and rapid onset (RSI)

degraded by plasma CE

s/e: rhabdo, ocular HTN, malig hyperthermia, hyperK

c/i: spinal cord injury, renal failure, large burns

257
Q

Tx for beta blocker overdose

A

glucagon

258
Q

Steps of rapid sequence intubation

A

c-spine stabilize → preO2 → fentanyl → etomidate → succinylcholine

259
Q

Atropine

A

competitive inhibitor of ACh at muscarinic receptor liver metabolism

260
Q

Neostigmine

A

reversal of non-depol muscle relaxants AChE inhibitor

261
Q

NO

A

little myocardial depression

rapid uptake and elimination

not strong enough as single agent

262
Q

Halothane

A

cheapest

effective at low concentration

s/e- ventricular arrhythmia, hepatic necrosis

263
Q

Sevoflurane

A

rapid induction

s/e- expensive, liver metabolism

264
Q

Isoflurane

A

strong vasodilator

less myocardial depression (still more than NO)

265
Q

Latent error

A

2/2 condition of system being removed; evident after a “perfect storm”

266
Q

SCIP guidelines

A
  • Ppx abx 1 hour before incision (vanc can be 2hr)
  • DC abx 24h after end time
  • 48h for cardiac surgery
  • Cardiac pt should have glucose should be < 200 on POD1 and 2
  • Shaving is inappropriate; should clip hair
  • Remove foley on POD1 or 2
  • Maintain normothermia (=> than 36)
  • Recieve BB 1 day prior to surgery through POD2
  • VTE prophy within 24h of end time
267
Q

Periop DM management

A

Oral agents:

  • hold ON THE MORNING of surgery.
  • Resume after surgery (EXCEPT for metformin)

Rapid IV agents:

  • withhold while NPO and use with a sliding scale

Intermediate/Long acting:

  • give normal dose the night before
  • Give ½ dose the morning of surgery

Pump: keep a basal insulin infusion on the day of surgery - use pump to correct levels as needed

268
Q

Peri-op anti-PLT agents

A

Clopidogrel (plavix): hold 5-7 days before elective surgery

ASA: continue through the surgery

269
Q

Epidural hematoma

A

Biconvex

MMA

DOES NOT suture lines

270
Q

CPP

A

MAP - ICP

271
Q

Vitamin K

A

gamma CARBOXYLATION (not decarb) of GLUTAMATE on 2, 7, 9, 10, c, s

272
Q

Warfarin

A

competitive inhibitor of epoxide reductase (vit K activator)

273
Q

Kcal per macronutrient

A

protein = 4 kcal/g

dextrose = 3 kcal/g

lipid = 4 kcal/g

carb = 4 kcal/g

274
Q

Glycogen

A

stores depleted after 24-48h of starvation

MOST found in skeletal muscle, rest in the liver

275
Q

Zinc def

A

skin rash, impaired wound healing, testicular atrophy

276
Q

Selenium def

A

cardiomyopathy, hypothyroid

277
Q

Chromium

A

hyperglycemia, confusion, neuropathy

278
Q

Copper def

A

pancytopenia, myelopathy, pigmentation change

279
Q

Iron def

A

anemia, glossitis, brittle nails, cardiomegaly

280
Q

B12 def

A

megalo anemia, neuropathy

281
Q

Respiratory quotient

A

CO2 produced / O2 consumed

>1 → carb is major nutrient

.7 → lipids major nutrient

282
Q

preA vs. Albumin

A

Prealbumin: t1/2 is 1-2 days; best marker for short-term nutritional status

Albumin: t1/2 is 21 days; biomarker of long term nutrition; pre op assessment

283
Q

Silvadene, mafenide, silver nitrate s/e

A

Silvadene: s/e- neutropenia, hypersensitivity, kernicterus (avoid in preg)

Mafenide: s/e- met acidosis

Silver Nitrate: s/e- hypoNatremia

284
Q

neostigmine

A

MOA: increased PS activity (AChE-I)

tx for ogilvie’s

MONITORED SETTING w/ atropine b/c high r/o BRADYCARDIA

b4 r/o mech obsxn 1st or r/o perf b/c of enhanced motility and pressure

285
Q

Reversals:

  • BB
  • Tylenol
  • Benzos
  • CN/Nitroprusside
  • Vecuronium/Rocuronium
  • Ethylene glycol
  • Methemoglobinemia
A
  • BB overdose: fluids/atropine → glucagon
  • Tylenol: NAC
  • Benzos: fluamzenil
  • CN/Nitroprusside: sodium thiosulfate, amyl nitrite
  • Vecuronium/Rocuronium: sugammadex
  • Ethylene glycol: femopizole and bicarb OR ethanol; iHD
  • Methemoglobinemia: methylene blue
286
Q

Ethylene glycol toxicity

A

metabolized in the liver oxalate stones → renal failure anion gap met acid

287
Q

SD

A

1, 2, and 3 SD = 67%, 95%, and 99.7% of the data

288
Q

Se, Sp

A

Sensitivity = of the people who have the disease how many test positive

Specific = of the people who don’t have the disease how many test negative

289
Q

PPV, NPV

A

PPV = of the people who test positive how many have the disease

NPV = of the people who test negative how many do not have the disease

290
Q

NNT`

A

NNT = 1/absolute risk reduction (ARR)

ARR = event rate in intervention group - rate in null group

291
Q

type 1 vs. type 2 error

A

type 1: false positive

type 2 false negative

292
Q

T and N staging eso cancer

A
  • t1a- LP and MM
  • t1b- SM
  • t2- MP
  • t3- adventitia
  • t4a- resectable structures
  • t4b- unresectable structures

n1: 1-2 nodes
n2: 3-6 nodes
n3: 7+

293
Q

Indications for neoadjuvant therapy eso cancer

A

t1b and above OR

any nodal involvement

294
Q

tx of eso cancer by t stage

A

t1a- mucosal resection

t1b- esophagectomy

t2- esophagectomy

t3- esophagectomy

t4a- esophagectomy

t4b- chemo/rads

cervical- chemo/rads

295
Q

layers of the eso

A
  1. Mucosa
    • epithelium
    • LP
    • MM
  2. Sub-mucosa (lots of lyphatics!)
  3. MP
  4. Adventitia

NO serosa!

296
Q

T staging indications for neoadjuvant

  • eso
  • stomach
  • colon
  • rectal
A
  • eso: t1b (SM)
  • stomach: t2 (MP)
  • colon: t4b (adjacent organs)
  • rectal: t3 (through MP)
297
Q

Tx of liver lesions

A
  • Hemangioma: only if sxatic
  • FNH: NTD
    • Adenoma: if > 4cm or < 4cm w/out OCP reponse
298
Q

Liver collection tx

A

Pyogenic- drain and abx

Amoebic- metronidazole

Echinococcal- albendazole and resect

299
Q

MELD

A
  1. Bili
  2. INR
  3. Creatinine
300
Q

Enzymes secreted in their active form from pancreas

A

Amylase

Lipase

Ribonuclease

Deoxyribonuclease

301
Q

Stage 3 breast cancer

A

3a- 4 to 9 nodes

3b- chest wall or breast skin

3c- supra clavicular nodes

302
Q

Howship-Romburg Sign

A

Pain in medial thigh with internal rotation and extension

Suggests an obtruator hernia

303
Q

dx of colovag and colovesic fistula

A

colovag: tampon test
colovesic: CT scan

304
Q

Scope schedule after Crohn’s dx

A

10 years after dx then every year to r/o dysplasia

305
Q

Paget-Schroetter syndrome

A

Exercose induced thrombosis of subclavian/axillary VEIN

Tx- catheter directed thrombolysis

306
Q

Generic nitrogen need

A

1g of nitrogen for every 150 kcal

307
Q

clostridua

A

GPR

MC CO emphysematous cholecystitis

308
Q

Treatment of Merkel Cell

A

excision

highly radiosensitive. radiate if > 2cm

SLNBx

309
Q

Gardner syndrome

A

epidermal cysts, GI polyposis, osteomas

310
Q

Hyperacute rejection mechanism

A

Host IgG towards class 1 MHC

311
Q

Cause of:

graves

TMN

Hashimoto’s

DeQuervains

A

graves- IgG against TSHr

TMN- hyperplasia 2/2 low grade TSH stimulation

Hashimoto’s- antiTG abs (cell-med and humoral)

DeQuervains- viral URI

312
Q

Specific to UC

A

Crypt abscess

Psuedopolyps

313
Q

Specific to Crohn’s

A

Creeping fat

Skip lesions

Transmural

314
Q

Polyps that require surgery instead of endoscopic resection

A

Submucosal invasion > 1mm

Poorly differentiated

<1 mm margin

Lymphovascular invasion

Tumor budding

315
Q

Fibrin

A

Links Gp2b/3a to form PLT plug

316
Q

Thrombin functions

A
  1. Fibrinogen to fibrin2. Activates f5, 83. Activates PLTS
317
Q

AT3 Functions

A
  1. Inhibits thrombin2. Inhibits f9, 10, 11
318
Q

Plasmin

A

Degrades f5, 8, fibrinogen, and fibrin

319
Q

TXA2

A

Released from PLTCa release exposes Gp2b/3aIncreases PLT aggregation and promotes constriction

320
Q

Cryo

A

vWF, f8, fibrinogen

321
Q

FFP

A

All factors, Protein C and S, AT3

322
Q

DDAVP

A

Cause endothelium to release f8 and vWF

323
Q

Clopidogrel

A

MOA: ADP receptor (gp2b/3a) antagonist

324
Q

Aminocaproic acid

A

Plasmin inhibitorUse: DIC, excess tpa

325
Q

Warfarin reversal

A
  1. Emergent: PCC or f7a (more s/e)2. Oral K
326
Q

Anti-staph Penicillins

A

OxacillinMethicillinNafcillin

327
Q

Beta lactamase inhibitors

A

SulbactamClavulanic acidTazobactam

328
Q

Effective for enteroccous

A

AmpicillinAmoxacillinVancomycinTimentinZosyn***resistant to all cephalosporins

329
Q

Effective for P/A/S

A

Ticarcillin, Piperacillin, TimentinZosyn3G cephalosporinAminoglycodies (genta, tobra)Meropenem, ImipenemFlouroquinolones

330
Q

Effective for VRE

A

SynercidLInezolid

331
Q

P450 inducers

A

Cruciform vegetablesETOHCigarette smokePhenobarbBarbituratesDilantinTheophyllineWarfarin

332
Q

P450 inhibitors

A

CimetidineIsoniazidKetoconazoleErythromycinCiproFlagylAllopurinolVerapamilAmiodaronsMAOiDisulfuram

333
Q

Halothane

A

Slow onset/offset. Least pungent (children)s/e:- highest cards depression and arrhythmia- halothane hepatitis- avoid w/ neurosurg

334
Q

Sevoflurane

A

fast, less laryngospasm, less pungentgood for mask induction

335
Q

Isoflurane

A

Good for neurosurgeryPungent (not used for induction)

336
Q

Propofol

A

Rapid distribution and on/offs/e- hypotension, resp depression, meta acidmetabolism- liver

337
Q

Ketamine

A

No respiratory depressions/e- hallucination, catelcholamine release, airway secretions, increased CBF- c/i in head injury

338
Q

Etomidate

A

Fewer hemodynamic changesFast actingFewest cards s/es/e- adrenocortical suppresion w/ cont infusion

339
Q

Dexmedetomidine

A

Mech- CNS alpha2 agoNot an induction agent. Good for intubated ptsAnesthesia and analgesias/e- not for more than 24h

340
Q

Depolarizing agents

A

Succinyl choiceMalignant hyperthermiaHyperkalemiaGlaucoma

341
Q

Ca EKG

A

HyperCA- Short ST, wide THypoCA- long QT

342
Q

HypoMg EKG

A

Tall t wavesDepressed ST

343
Q

K ECG

A

HyperK- Peaked T, wide QRS, long PRHypoK - ST depression, inverted T

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