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zAbsite Final 2019 > TRUE LEARN - ABSITE 2019 > Flashcards

TRUE LEARN - ABSITE 2019 Flashcards

1
Q

Tx of SIADH

A

fluid restriction

demeclocycline or vaptans (adh inhibitor)

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2
Q

Portal vein thrombosis tx

A

Control HMHG with variceal ligation

Anticoagulate once bleeding controlled

Consider distal spleno-renal shunt

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3
Q

MRSA tx

A

vancomycin

if vanc resistant then linezolid

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4
Q

VWF

A

binds GP1b on PLTs and attaches them to endothelium

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5
Q

Margin for invasives cancer vs. dcis

A

invasive cancer- gross negative

dcis- 1 to 2 mm

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6
Q

Interleukins 1, 2, 4

A

IL1: fever

IL2: T cell prolif and Ig production

IL4: T/B cell maturation

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7
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

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8
Q

Hormones that increase LES pressure

A

Gastrin

Motilin

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9
Q

Origin of med thyroid cancer

A

4th pharyngeal arch NCC –> parafollicular C cells

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10
Q

Gardner syndrome

A

epidermal cysts, GI polyposis, osteomas

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11
Q

Indidcations for operative treatment of eso perf

A
  • early postemetic perforation
  • hemodynamic instability
  • intra-abdominal perforation
  • extravasations of contrast into adjacent body cavities
  • presence of underlying malignancy, obstruction or stricture

place jejunostomy tube for feeding after. don’t place gastric tube (conduit)

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12
Q

Uremic PLT dysfunction

A

2/2 renal disease

reversible dysfunction

tx- ddavp

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13
Q

B12 def

A

megalo anemia, neuropathy

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14
Q

Traction vs. Pulsion Diverticulum

A

traction- inflammation; all 3 layers; mid eso

pulsion- pressure; 2 layers; above circoph.

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15
Q

Positioning for indirect laryngoscopy

A

sitting upright with a straight back, leaning slightly toward you with chin pointing upward (“sniffing position”)

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16
Q

Kcal per macronutrient

A

protein = 4 kcal/g

dextrose = 3 kcal/g

lipid = 9 kcal/g

carb = 4 kcal/g

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17
Q

p53

A

TSG on Ch17

cell cycle regulation and apoptosis

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18
Q

Rule of 9s

A

Each arm 9

Each leg 18

Ant belly 18, Post belly 18

Each hand 1

Ant face 4.5, Post face 4.5

Genitals 1

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19
Q

EBV associated with

A

B cell lymphome (Burkitt)

n/ph cancer

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20
Q

FRC

A

Volume of the lung after normal tidal expiration

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21
Q

Cisatracurium

A

non-depolarizing

cleared by Hoffman degradation

use in pts w/ renal and hepatic disease

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22
Q

tacro

A

MOA: calcineurin inhibitor (binds fK)

s/e- nephrotoxic, p. neuropathy, allopecia

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23
Q

SD

A

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

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24
Q

Intraductal papilloma

A

MCCO bloody nipple d/c

tx w/ duct excision

no increased r/o ca

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25
Q

Blood supply to esophagus

A

Upper 3rd- inferior thryoid artery

Middle 3rd- thoracic aorta

Lower 3rd- left gastric

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26
Q

Pleomorphic adenoma

A

MC benign H/N tumor

middle aged woman

slow growing; t2 bright

Tx: superficial parotidectomy even if asx

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27
Q

Rule of 6s

A

flow > 600/min

diameter > 6mm (after placement)

depth of 6mm

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28
Q

Comparing pressors

A

Norepi: alpha1 > alpha2, beta1

Epi: beta1, alpha1 > beta2, alpha2

Phenylephrine: alpha1 > alpha2 (no beta)

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29
Q

MCCO of spontaneous bacterial peritonitis

A

E. Coli

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30
Q

Max dose of lido and bupiv

A

lido = 5mg/kg (7 w/ epi)

bupiv = 2.5 mg/kg

tx- lipid emulsion

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31
Q

Lamivudine

A

rTranscriptase inhibitor

Tx for hep B at low doses; HIV at high doses

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32
Q

Wound healing order of entry

A

plts → PMNs → macrophages → fibroblast → keratinocytes

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33
Q

5Ts of cyanosis

A
  1. TOF
  2. Transposition of GVs
  3. Truncus art
  4. Tricuspid atresia
  5. TAPVC
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34
Q

Pain after inguinal hernia repair

A

Ilioinguinal nerve

Injured at external ring. Lies anterior to cord

tx- local injection

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35
Q

Staging adrenal cancer

A

s1- <5cm

s2- >5cm

s3- n1 or t3

s4- mets

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36
Q

location of vagus nerve

A

LARP left anterior, right posterior to esophagus

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37
Q

Dopamine dosing

A

low- d1/2 ago (renal dose)

medium- B ago

high- A ago

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38
Q

LIPID A

A

Gram negative bacteria (Klebsiella)

lipopolysaccharide layer endotoxin → septic shock

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39
Q

Beta lactamase inhibitors

A

Sulbactam/Tazobactam

Clavulanic acid

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40
Q

Contents of ant triangle

A

Carotid sheath, anca cervicalis, CN 12 (hypoglossal)

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

  • facial vein is the gateway
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41
Q

BRCA risks

A

female breast, ovarian, male breast

I- 60, 40, 1

II- 60, 10, 10

Women with BRCA breast CA have the same prognosis stage for stage as non-BRCA breast CA

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42
Q

Kasabach-Merritt Syndrome:

A

hemangioma + thrombocytopenia

usually infants

resect!

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43
Q

Traumatic renal artery thrombosis

A

Unilateral- anticoagulation

Bilateral- OR or IR stent

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44
Q

Adenoid cystic carcinoma

A

MC minor salivary gland tumor (SM gland)

propensity for perineural invasion

Remains quiescent for years then metastasizes aggressively

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45
Q

SLNBx for melanoma

A

< .75 mm none

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

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46
Q

Hernia repairs:

Bassini

McVay

Lichtenstein

A

Bassini: CT to IL

McVay: CT to cooper’s

Lichtenstein: mesh

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47
Q

Casues of increased ETCO2

A

Increased muscle activity (shivering)

Increased metabolism (sepsis, fever, malignany hyperT)

Increased CO

Decreased minute ventilation

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48
Q

Acute cellular rejection

A

T cell mediated

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

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49
Q

Phyllodes tumor

A

“sarcoma of the breast”

tx- en bloc resection

hematog spread- chemo/LN dissection unnneccesary

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50
Q

Birads 0

A

More imaging: mammogram or targeted US

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51
Q

Mediastinal tumors

A

Anterior: lymphoma MC in children, thymoma MC in adults

Middle: lymphoma MC

Posterior: neurologic MC

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52
Q

Vitamin C

A

hydroxylation of lysine and proline

type 3 collagen cross-linking

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53
Q

Staph virulence factors

A
  1. protein A: binds Fc component of IgG, forcing variable region to face away from bacterium
  2. Enterotoxins: intestines
  3. Toxic shock syndrome toxin-1 (TSST-1): superantigen. binds MHC II and T-cell receptor
  4. Coagulase: converts fibrinogen to fibrin clot
  5. Exfolatins: skin-exfoliating toxins
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54
Q

CN11

A

spinal accessory nerve

exit jugulars foramen

innervates SCM and trapezius goes along post triangle

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55
Q

Tx of SVC syndrome

A

Angio stenting and steroids for sxatic relief

Urgent chemo/rads therapy

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56
Q

Silvadene, mafenide, silver nitrate s/e

A

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

Mafenide: psuedomonas coverage s/e- met acidosis

Silver Nitrate: s/e- hypoNatremia

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57
Q

Indications for radioiodine thereapy

A

2-4 cm mass

vascular invasion

anti-Tg Ab

TG < 5

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58
Q

Hemophilia A

A

f8 DEFICIENCY SLR

MC inherited disorder

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

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59
Q

Strongest layer of bowel

A

SM

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60
Q

Contents of post triangle

A

CN 11 subclavian artery

EJV

brachial plexus trunks

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61
Q

Paget-Schroetter syndrome

A

Exercise induced thrombosis of subclavian/axillary VEIN

Tx- catheter directed thrombolysis

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62
Q

NEC

A

Bloody stools after 1st feed

dx- pneumatosis

tx- resuscitation, abx; OR if free air, clinical deterioration

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63
Q

Fibroadenoma

A

cyclical pain

dx- US guided core bx

only excise if discordance with biopsy!

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64
Q

Pancuronium

A

non-depol

eliminated by kidney and liver

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65
Q

Location of superior sympathetic block

A
  • 3 to 5 cm in length
  • on the longus capitus muscle
  • anterior to the transverse process of the second, third, and rarely the fourth cervical vertebrae
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66
Q

Order of contents in thoracic outlet

A

vein (SC)

phrenic

muscle (scalene)

artery (SC)

nerve (br plexus)

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67
Q

Insulinoma

A

Loc: throughout

Px: whipple’s triad

tx- < 2cm encucleate, >2cm resect

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68
Q

GCS verbal

A

5- normal

4- confused

3- inappropriate words

2- incomprehensible

1- none

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69
Q

Plasmin

A

Degrades f5, 8, fibrinogen, and fibrin

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70
Q

TXA2

A

vasoconstrictors

released by PLTs

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71
Q

Pseudocyst

A

encapsulated

lack epithelial lining

>5cm requires drainage

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72
Q

Sevoflurane

A

fast, less laryngospasm, less pungent

good for mask induction

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73
Q

Fibrin

A

Links Gp2b/3a to form PLT plug

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74
Q

NOAC reversak

A

Dabigatran (pradaxa)- Idarucizumab, iHD

Apixaban- PCC (partial)

Rivoroxaban- PCC (partial)

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75
Q

Indications for post op radio-iodine

A

2-4 cm

vascular invasion

anti-Tg Ab

TG<5

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76
Q

PEAK and TROUGH

A

PEAK- amount

TROUGH- frequency

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77
Q

Desmoid tumor

A

Locally aggressive with no portential for mets

Tx with resection and chemo

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78
Q

MC vitamind def after REY GB

A

B12

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79
Q

Ulcers:

Marginal

Cameron

Marjolin ulcer

Cushing’s ulcer

A

Marginal- REYGB at GJ anastomosis

Cameron- on lesser curve of large hiatal hernia

Marjolin ulcer- chronic wound

Cushing’s ulcer- elevated ICP

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80
Q

Products of posterior pituitary

A

“PAO in the POST”

ADH, Oxytocin

2/2 direct stem from neurosecretory cell

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81
Q

Stage 3 breast cancer and tx

A

3a- 4 to 9 nodes –> consider neoadj for BCT

3b- chest wall (not pec wall) or breast skin –> neoadj required

3c- supra clavicular nodes –> neoadj required

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82
Q

Tx of GIST

A

Resection w/ gross margin

No LN dissection

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

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83
Q

Non-cyanotic heart defects

A

ASD

VSD

coarctation

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84
Q

Bevacizumab

A

recombinant humanized monoclonal antibody that blocks angiogenesis by inhibiting VEGF-A

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85
Q

c/i to BCT

A

multicentric

inflammatory ca

c/i to radiation

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86
Q

AT3 Functions

A

Inhibits thrombin2. Inhibits f9, 10, 11

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87
Q

Ranson’s criteria on admission

A

“GA Law”

  1. Glu > 200
  2. age > 55
  3. LDH > 350
  4. AST > 250
  5. WBC > 16
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88
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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89
Q

Glycogen

A

stores depleted after 24-48h of starvation

MOST found in skeletal muscle, rest in the liver

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90
Q

Types of esophogectomy

A

Transhiatal- laparotomy and cervical incision/anast

Ivor Lewis- thoracic incisions/anast

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91
Q

type 3 choledochocal cyst

A

choledochocele

tx- transduodenal marsupialization or excision

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92
Q

Treatment of colo-cutaenous fistula

A
  • Start with conservative tx
  • High output: > 500 cc/day –> likely OR
  • Low Output: < 200 cc/dayt –> likely conservative
  • OR if failed after about 6 weeks
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93
Q

CPP

A

MAP - ICP

normal CPP > 60

Normal ICP < 20

hyperventilation to 35 decreases CO2 causing vascoconstriction and decreasing ICP

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94
Q

Accessible nodal stations w/ EBUS

A

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

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95
Q

tx of Meckels

A

tx- resection if sxs.

  • if appendicits leave Meckel’s alone
  • If no appendicitis take out the Meckel’s

Only consider taking out incidentally found asx Meckel’s in young/healthy pt

if bleeding, inflamed or tumor at base –> segmental resection

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96
Q

Hypocalcemia

A

tingling

chvostek/trousseau sign

EKG- qt prolongation

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97
Q

Angiodysplasia of the colon

A

2nd MC CO gi bleed (vs. div’s)

Usually found in cecum and ascending colon

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98
Q

Effective for enteroccous

A

Ampicillin/Amoxacillin

Vancomycin

Timentin/Zosyn

(Resistant to all cephalosporins)

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99
Q

Lateral to medial femoral anatomy

A

Femoral nerve

Femoral artery

Femoral vein

Empty space (hernia)

Lacunar ligament

Superficial ring

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100
Q

Gastrin

A

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

Stimulated by ACh, beta ago, AA

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101
Q

Tx for gallstone ileus

A

Stable and healthy- stone removal and take down fistula

Unstable- stone removal only!

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102
Q

septic shock

A

high CI, low SVR, +/- wedge

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103
Q

Normal SBP in a neonate

A

60-90

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104
Q

How to reach D2 during EGD

A

right rotation and manipulate the up/down control knob

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105
Q

S/e of tamoxifen

A

dvt/pe

uterine cancer

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106
Q

Best test for resectability and staging of eso cancer

A

Resectability- ct

Staging- US

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107
Q

Specific to UC

A

Crypt abscess

Psuedopolyps

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108
Q

LeFort fxs

A

I- palate

II- nose and palate

III- entire face

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109
Q

Epoteitn

A

stimulated by HYPOXIA produced by kidney fibroblasts

Liver is major producer of EPO in fetus

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110
Q

Cutoff for low risk lung nodules not requiring follow-up

A

6mm

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111
Q

Best opioid to use for AKI

A
  • methadone and fentanyl/sufentanil
  • hydromorphone or oxycodone are used with caution

morphine and codeine are avoided

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112
Q

Anti-staph Penicillins

A

Oxacillin

Methicillin

Nafcillin

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113
Q

Bile concentration

A

Sodium chloride channels actively transport salt across the epithelium efficiently and water follows passively in response to the resultant osmotic force

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114
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

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115
Q

Hurthle cell

A

Usually benign

MUST do lobectomy to diagnose

tx- total thyroid if malignant. XRT effective.

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116
Q

Neostigmine

A

reversal of non-depol muscle relaxants AChE inhibitor

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117
Q

Imaging associated with benign adrenal mass

A

< 10HU

Rapid washout

< 4cm

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118
Q

ITP

A

px- petechiae and megakaryotcytes

tx- steroids (IVIG 2nd line)

  • do not tx unless PLT < 30k or 20k in low risk
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119
Q

Paired vs. unparied t test

A

Paired- compares study subjects at 2 different times (paired observations of the same subject)

Unparied- compares two different subjects

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120
Q

Respiratory quotient

A

CO2 produced / O2 consumed

>1 → carb is major nutrient

.7 → lipids major nutrient

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121
Q

Absolute c/i to spinal anesthesia

A

Infection at the site

Hypovolemia

Allergy

Increased ICP

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122
Q

Parkland formula

A

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

2nd half next 16

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123
Q

Steps of rapid sequence intubation

A

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

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124
Q

Where to find superior and inferior PD during a whipple

A

Superior: pancreatic head

Inferior: uncinate process

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125
Q

Tx of Barrett’s

A

low grade dysplasia: repeat scope/bx in 6m

high grade dysplasia: endoscopic mucosal resection

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126
Q

cyclosporine

A

MOA: calcineurin inhibitor

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

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127
Q

Effective for VRE

A

Synercid

Linezolid

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128
Q

Kaposi’s sarcoma

A

HSV8

Violet/brown papules

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129
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+

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130
Q

CRC T and N

A

t1- SM

t2- MP

t3- xMP/subserosa

t4- invade

n1- 1-3, n2- >=4

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131
Q

Triple therapy

A

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

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132
Q

Chole docho in REY bypass pt

A

w/ GB –> lap chole with CBD exploration –> ERCP through remnant stomach

w/out GB –> ERCP with double balloon endoscopt –> ERCP throught remnant stomach

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133
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
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134
Q

Howship-Romburg Sign

A

Pain in medial thigh with internal rotation and extension

Suggests an obtruator hernia

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135
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

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136
Q

Most abundant bacteria in the colon

A

Bacteroides fragiles

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137
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
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138
Q

Number of lung segments

A

R-10

L-8

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139
Q

confounding

A

a variable that influences both the dependent variable and independent variable causing a spurious association

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140
Q

Epidural hematoma

A

Biconvex

MMA

DOES NOT suture lines

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141
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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142
Q

Effective for P/A/S

A

Ticarcillin (+ticarcillin), Piperacillin (+Zosyn)

3/4G cephalosporin (ceftriaxone, cefepime)

Aminoglycodies (genta, tobra)

Flouroquinolones

Meropenem/Imipenem

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143
Q

HNPCC and criteria

A

HNPCC pts who fulfill Amsterdam clinical criteria for Lynch syndrome

Criteria:

  • 3 relatives (one 1st deg) w/ Lynch syndrome-associated cancer (CRC, endometrial, small bowel, ureter/renal)
  • 2 successive generations
  • 1 < 50 yo
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144
Q

MALT lymphoma

A

associated w/ h. Pylori.

Tx:

  • Low grade: triple therapy
  • High grade: chemo and XRT (CHOP) +/- rituximab
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145
Q

MCCO chylous ascites

A

malignancy

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146
Q

Gastroschisis

A

GastRoschisis to the Right of midline

rare defects…EXCEPTION- instestinal atResia

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147
Q

Tx of AT3 def

A

Heparin does not work!

Tx- recombinant at3 or FFP followed by heparin then warfarin

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148
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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149
Q

STSG vs. FTSG

A

STSG- epi + part dermis; worse cosmesis; more contracture! (don’t use over joints)

FTSG- epi + dermis; lower survival; more resistant; hypertrophic scar formation; more sensation

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150
Q

ASA

A

irreversible inhibitor of PG metabolism in PLTs

2/2 cox acetylation

7-days of PLT dysfunction

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151
Q

Tx for beta blocker overdose

A

glucagon

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152
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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153
Q

Rapid coumadin reversal

A

PCC

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154
Q

Pyoderma gangrenosum

A

associated w/ IBD

RESOLVES after resection

pre-tibial

tx- steroids

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155
Q

Central cord syndrome

A

loss of pain, temp, motor

motor UE> LE loss (vs. anterior syndrome)

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156
Q

Scope schedule after Crohn’s dx

A

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

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157
Q

TNFa

A

produced by macrophages

causes cachexia

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158
Q

Beckwith Wiedmann Syndrome

A

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

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159
Q

type 1 choledochocal cyst

A

fusiform dilation tx- excision w/ REY H-J

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160
Q

Cryo

A

vWF, f8, fibrinogen

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161
Q

Breslow depth

A

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

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162
Q

Best test to dx gastroparesis

A

Scintigraphic gastric emptying

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163
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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164
Q

FFP

A

All factors, Protein C and S, AT3

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165
Q

Child’s Pugh Score

A

Billirubin, Albumin, INR, Ascites, Encephalopathy

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166
Q

ARDS ratio

A

P/F

  • mild- 200 to 300
  • moderate 100-200
  • severe < 100
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167
Q

Orientation of portal triad

A

Bile duct lateral

Hepatic artery medial

Portal vein posterior

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168
Q

Schiatzki’s Ring

A

Associated with hiatal hernia

Tx- only if sxatic. dilation and PPI; do not resect

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169
Q

MOA reglan and erythromcyin

A

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

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170
Q

indications to bx a neck mass

A

confirm FNA or core needle with excisional biopsy!

  • >1.5 cm
  • enlarged node without signs of infection
  • persistence after trial of antibiotics and observation >2-4 wks
  • increasing size of mass
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171
Q

Peri-op anti-PLT agents

A

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

ASA: continue through the surgery

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172
Q

neurogenic shock

A

high CI, low SVR, low wedge

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173
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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174
Q

Breast Cancer in pregnancy

A

1T- MRM. Chemo is not OK.

2T/3T- consider BCT. Modfied radio-isotope. Chemo is OK. Post delivery radiation.

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175
Q

Who needs stress dose steroids

A

>20 mg of steroids for > 3 weeks

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176
Q

Frey syndrome

A

gustatory sweating s/p parotidectomy

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177
Q

Layers of colon/rectum

A
  1. mucosa
  2. sub-mucosa
  3. muscularis propria
  4. serosa
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178
Q

FNH

A

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

tx- resect if sxatic. no malignant potential.

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179
Q

TOF

A

Most common cyanotic defect

VSD, PS, OA, RVH

tx- beta blocker; surgery at 3-6m

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180
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

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181
Q

Hard signs of vascular injury

A

shock

expanding hematoma

pulsatile bleed

thrill/bruit

absent pulse

ischemia

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182
Q

Primary lymphoid organ vs. secondary

A

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

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

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183
Q

Tx of liver lesions:

Hemangioma

FNH

Adenoma

A
  • Hemangioma: only if sxatic or KM syndrome
  • FNH: NTD
  • Adenoma: < 4cm w/out OCP response or > 4cm
184
Q

s/e of silver nitrate, silver sulfadiazene, mafenide

A

Silver nitrate- eletrolytes disturbace (no sulfa)

Silver sulfadizene- neutropenia, sulfa

Mafenide- met acidosis, sulfa

185
Q

Tx of complete CBD transection

A

REY HJ has better long term outcome than primary repair

186
Q

Indications for neoadjuvant therapy for stomach cancer

A

Any T2 lesion or LN involvement

T2: growth into the muscularis propria

187
Q

Number of LN needed for gastric vs. CRC

A

gastric- 15 CRC- 12

188
Q

Thyroid ima

A

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

189
Q

long chain vs. medium chain TG

A

LC- absorbed by lymphatics

MC- absorbed into blood

190
Q

Fuel for SB and LB

A

SB- glutamine

LB- SCFA

191
Q

Torsades

A

2/2 hypoK, hypoCa, hypoMg

all cause qt prolongation

192
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
193
Q

Thoracic duct course

A

originates at L1-L2 @ c. chyli

cross from R to L at T4-5

empties into L SC/IJ jxn

194
Q

TOF anomalies

A
  1. Over-riding aorta
  2. RV hypertrophy
  3. VSD
  4. RV obstruction
195
Q

Sevoflurane

A

rapid induction, less laryngospasm, less pungent

good for mask induction

s/e- expensive, liver metabolism

196
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)

197
Q

Screening guidelines for breast ca

A

annual screening at age 40

198
Q

DDAVP

A

Cause endothelium to release f8 and vWF

199
Q

Iron def

A

anemia, glossitis, brittle nails, cardiomegaly

200
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
201
Q

Vitamin K

A

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

202
Q

Spigelian hernia

A

found along semilunar line lateral to rectus

all should be repaired

203
Q

Ethylene glycol toxicity

A

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

204
Q

type 4 choledochocal cyst

A

extra/intra dilations

tx- excision w/ REH H-J

205
Q

Hyperacute rejection mechanism

A

Host IgG towards class 1 MHC

206
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

207
Q

Isoflurane

A

good for neurosurgery; no increase in ICP

208
Q

Indications for neoadjuvant therapy eso cancer

A

t1b and above OR

any nodal involvement

209
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
210
Q

Peutz-Jeghers

A

AD

Px- intestinal hamartomas, pigmented oral mucosa

Start screening at 25; scope q2 years

211
Q

T and N staging for gastric cancer

A

t1- SM

t2- MP

t3- xMP/subserosa

t4- invade

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

212
Q

MC uni-microbial CO nec fasc

A

Clostridium perfringens

gas gangrene

anaerobic

213
Q

Calcitonin

A

Parafollicular C cells Inhibits osteoclast resorption

Increases Ph excretion

214
Q

Halothane

A

Slow onset/offset.

Least pungent (children)

s/e:- highest cards depression and arrhythmia

  • halothane hepatitis
215
Q

types of endoleak and tx

A

1- proximal or distal seal –> emergent!

2- back bleeding

3- graft defect (tear or overlap leak) –> emergent!

4- porosity

216
Q

ASD

A

L to R shunt

Ostium primum (down syndrome) and secundum

Paradoxical emboli

Repair at 1-2y

217
Q

Atropine

A

competitive inhibitor of ACh at muscarinic receptor liver metabolism

218
Q

Zinc def

A

skin rash, impaired wound healing, testicular atrophy

219
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

220
Q

MCCO Cancer

A

Male- prostate, lung, CRC

  • lung, prostate, CRC

Women- breast, lung , CRC

  • death: lung, breast, CRC
221
Q

Hereditary pancreatitis

A

PRSS1 trypsinogen mut’n

AD

smoking cessation is important

222
Q

type 2 choledochocal cyst

A

cystic diverticula

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

223
Q

Reversals:

  • BB
  • Tylenol
  • Benzos
  • CN/Nitroprusside
  • Vecuronium/Rocuronium
  • Ethylene glycol
  • Methemoglobinemia
A
  • BB overdose: fluids/atropine → glucagon
  • Tylenol: NAC
  • Benzos: flumazenil
  • CN/Nitroprusside: sodium thiosulfate, amyl nitrite
  • Vecuronium/Rocuronium: sugammadex
  • Ethylene glycol: femopizole and bicarb OR ethanol; iHD
  • Methemoglobinemia: methylene blue
224
Q

TASC classifcation

A

TASC a and b usually get endovascular repair

A- < 3cm

B- 3-10 cm

225
Q

Superior laryngeal nerve

A

motor to cricothyroid injury: high pitch

226
Q

Lipopolysaccharide

A

cell wall of GN bacteria endotoxin

activates complements cascade → sepsis

227
Q

Tylenol metabolsim

A
  1. Glucuronidation (45-55%)
  2. Sulfation (sulfate conjugation) (20–30%)
  3. N-hydroxylation and dehydration, then glutathione conjugation, (less than 15%)
    • hepatic cytochrome P450 enzyme system
    • NAPQI
228
Q

F5 Leiden

A

resistance to protein C and S

acts w/ Xa to converts fibrinogen to fibrin

229
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)

230
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

231
Q

Treatment of Merkel Cell

A

excision

highly radiosensitive. radiate if > 2cm

SLNBx

232
Q

Mucoepidermoid carcinoma

A

MC malignant H/N tumor

233
Q

Staging GB cancer

A

1a- LP –> just cc’ectomy

1b- MM –> cc’ectomy, hepatic/ LN/duct resection

t2- perimuscular CT

t3- organs

234
Q

Copper def

A

pancytopenia, myelopathy, pigmentation change

235
Q

CRC staging

A

stage 1- t1 to t2, n0

stage 2- t3 to t4, n0

stage 3- node involvement

stage 4- m1

236
Q

sirolimus

A

MOA: mTOR inhibitor

s/e- lymphocele, wound complications

  • lymphcele can cause mesenteric mass and SBO

benefit- less nephrotoxic

237
Q

DES

A

unorganized peristalisis

normal LES pressure

normal relaxation

238
Q

Selenium def

A

cardiomyopathy, hypothyroid

239
Q

Clinical trial phase

A

1- determine safe dosing and route

2- evaluate effectiveness and side effects

3- determine if better than alternatives

4- follow individuals for s/e’s

240
Q

Echinoccocus

A

Hydatid cyst

tx w/ mebendazole

241
Q

Heparin

A

accelerates AT3 activity and INDIRECTLY inhibits thrombin

242
Q

hepatic adenoma

A

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

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

243
Q

Specific to Crohn’s disease

A

Cobblestoning

Granulomas

Transmural Fistulas

244
Q

Free water deficit

A

TBW x [(Na-140)/140]

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

245
Q

Spinal vs. Epidural

A

Spinal- below l1/l2; SA space; fast; n/m block

Epidural- any level; epidural space; slow; no block

246
Q

Tx SIADH

A

Chronic – Tx: fluid restriction and diuresis

Acute – Tx: conivaptan, tolvaptan

247
Q

Rocuronium

A

non-depol

rapid onset; best for short procedures

eliminated by liver only

248
Q

type 1 vs. type 2 error

A

type 1: false positive

type 2: false negative

power = 1 - type2

249
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

250
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)
251
Q

Ureter injuries

A

proximal ⅓ → primary ureterourostomy

middle ⅓ → primary or tran uretero urosotomy

lower ⅓ → re-implanation +/- hitch

252
Q

Hot vs. cold nodules

A

Hot- surgery or iodine ablation –> unlikely cancer

Cold- FNA –> may be cancer

253
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

254
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%

255
Q

Isoflurane

A

Good for neurosurgery

Pungent (not used for induction)

256
Q

Hyperkalemia EKG

A

peaked T wave

257
Q

Dexmedetomidine

A

Mech- CNS alpha2 ago

Not an induction agent. Good for intubated pts

Anesthesia and analgesia

s/e- bradycardia

258
Q

MC aortic infections

A

aneurysmal- staph

non-aneurysm- salmonella

259
Q

febrile transfusion rxn

A

RECIPIENTS Ab attack DONOR leukocytes

260
Q

Tx of breast CA in preg

A

partial mastectomy + radiation after preg OR full mastectomy

trastuzumab is c/i

261
Q

Octreotide

A

Somatostatin analogue

Inhibits exocrine function of pancreas and CCK release

Tx for chronic pancreatitis

262
Q

Latent error

A

2/2 condition of system being removed

evident after a “perfect storm”

263
Q

Specific to Crohn’s

A

Creeping fat

Skip lesions

Transmural

264
Q

Polyps that require surgery instead of endoscopic resection

A

Submucosal invasion > 1mm

Poorly differentiated

<1 mm margin

Lymphovascular invasion

Tumor budding

Sessile polyp (if you can’t get it all)

265
Q

Blood supply of pancreas

A

Head: superior PD and inferior PD

Body/tail: splenic

266
Q

Mondor disease

A

tender, “cord-like” structure

tx- NSAIDs

267
Q

Criteria for transanal excision of adenocarcinoma

A

T0 or T1 (submucosa)

< 3 cm

< 30% circumference

Palpable on DRE (<8cm from anal verge)

268
Q

Meckel’s Diverticulum

A

Anti-mesenteric border of SB

2/2 peristant viteline duct

pancreatic and gastric tissue

269
Q

Acetazolamide

A

Inhbitis carbonic anhydrase

Interferes with bicarb resorbtion causing non-AG metabolic acidosis

270
Q

hypovolemic shock

A

low CI, high SVR, low wedge

271
Q

Tx for hemobilia

A

angioembolization

272
Q

PFTs for lung resection

A

FEV1 >1.5L lobe, >2L pneumo –> OK for surgery

If not: lung scan

PPO FEV1 > .8L (>40%)

PPO DLCO > 10 ml/min/mmHg (>40%)

If not: exercise test

VO2 > 10 ml/min/kg –> OK for surgery

273
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

274
Q

dcis vs. lcis

A
  1. dcis: excisional bx
    • 1mm margin
    • no SLN unless mastectomy
  2. lcis: excisional bx
    1. margin for LCIS –> no further intervention. consider hormone tx or ppx mastectomy
    2. margin positive for DCIS/invasive ca –> surgery
275
Q

Sarcoma T and N staging

A

T1- <5 cm

T2- > 5cm

N1- regional nodes

276
Q

Etomidate

A

Fewer hemodynamic changes

Fast acting

Fewest cards s/e

s/e- adrenocortical suppresion w/ cont infusion

277
Q

basiliximab

A

MOA: IL2 inhibitor

278
Q

Midodrine

A

a1 agonist

279
Q

Li Fraumeni

A

p53 mutation

breast ca + soft tissue sarcoma

280
Q

Tx of Ogilvie’s

A

supportive, dc narcotics, ng tube, neostigmine

if > 10cm –> scope decompression and neostimgine

  • failure –> OR
281
Q

MCCO cauti

A
  1. e. coli
  2. enterococcus
  3. candida
282
Q

cardiogenic

A

low CI, high SVR, high wedge

283
Q

GCS eye opening

A

4- spon

3- to voice

2- to pain

1- none

284
Q

Dysplasia of any grade in the GI tract

A

polypectomy will suffice

need to re-scope in 3m if high grade or sessile

if there is SM invasion –> surgical resection

285
Q

Markers:

Ca 125

bHCG

AFP

Inhibin

A

Ca 125- epithelial

bHCG- choriocarcinoma

AFP- germ cell/endodermal/yolk sac

Inhibin- granulosa/sex-cord

286
Q

Inguinal hernia nerves

A

Ilioinguinal- MC in open repair; runs ant/top of cord; under EO

Iliohypogastric

GB of GF

Lateral femoral cutaneous- MC in lap repair; injured laterally

287
Q

Axis of gastric volvulus

A
  1. Organoaxial: rotate around the long/vertical axis
  2. Mesenteroaxial: rotate around wide/horizontal axis
288
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

289
Q

Somatostatinoma

A

Loc: head

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

290
Q

Tx of prolactinoma

A

if sxatic or macroadenoma

  • bromocriptine or carbegoline (both dopa agonists)
  • bromo is safe in pregnancy

surgery if failure

291
Q

Sub-acute thyroiditis

A

Recent viral URI

tx- NSAIDs/steroids

292
Q

Variceal bleeding 2/2 pancreatits

A

Splenic vein thrombosis

tx- splenectomy

293
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

294
Q

Loss in excess weight for each surgery

A

REYGB- 75%

SG- 60%

Lap band- 50%

295
Q

Gastric ulcers

A

1- lesser curve/antrum; normal acid

2- gastric + duo; high acid

3- pre pyloric: high acid

4- GE junction: normal acid

296
Q

Modified radical mastectomy

A

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

297
Q

layers of the eso

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

NO serosa!

298
Q

Duration of treatment - tamoxifen and trastuzumab

A

Tamoxifen- 5y

Trastuzumab- 1y

299
Q

F11 def

A

r/o bleeding w/ surgery

tx- FFP (not f11 concentrate!)

300
Q

Margin for LE sarcoma

A

2cm

301
Q

Somatostatin

A

D cells in stomach, duo and panc

Shuts off insulin, glucagon, and gastrin

Stimulated by acid

302
Q

Stimulation of CCK release

A

fatty acids and amino acids in the chyme entering the duodenum

CCK-releasing protein

ACh

303
Q

Order of potency of steroids

A
  1. HC
  2. Pred
  3. Methylpred
  4. Dexameth
304
Q

Cowden’s

A

pten mutation

breast ca + thyroid ca + hamartomas

305
Q

long thoracic nerve vs. thoracodorsal nerve

A

LTN → serratus –> winged scap

TD → LD –> difficult shoulder ADduction/Int rotation

306
Q

PLT count trx threhold

A

Stable and non-bleeding –> < 10K

Stable and non-bleeding with temp > 38 –> < 20k

Surgical pt < 50k

<20K spontaneous bleeds

307
Q

NNT`

A

NNT = 1/absolute risk reduction (ARR)

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

308
Q

half-life acoags:

war

hep

noac

A

war - 36h

hep 90m

noac- 12h

3.5 half lives to ss

309
Q

Achalasia

A

no peristalsis

high LES pressure

incomplete relaxation

310
Q

MEN syndromes

A

1- panc, pit, PT

2a- PT, MTC, pheo

2b- pheo, MTC, marfanoid/neuromas

311
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

312
Q

Types of Shunts

A
  1. Total: porto-caval, meso-caval
  • Relieves bleeding and ascites
  • More hepatic encephalopathy
  1. Partial: distal spleno-renal
    * Relives bleeding only
313
Q

Glucagonoma

A

Loc: distal

Px: dermatitis, DRH, DM, nec mig erythema

314
Q

MELD

A
  1. Bili
  2. INR
  3. Creatinine
315
Q

Pancreatic ducts

A

Wirsung- major, lies inferior

Santorini- minor, lies superior

316
Q

Hypokalemia EKG

A

qt prolongation

317
Q

Entamoeba histo

A

MExico

tx with MEtronidazole (no OR!)

NO rim enhancement (vs. amoebic abscess)

dx- EIA (assay)

318
Q

Group A strep

A

strep pyogenes

suspect if gas and bullae

319
Q

Imatinib

A

competitive inhibitor of TK

tx for GIST

320
Q

Tx of ovarian vein thrombosis

A

Anticoagulation

Abx if septic sxs

321
Q

Pyogenic abscess

A

MC- biliary dz and bile obstruction; e. Coli and kleb

tx- perc drainage is 1st line!

322
Q

clostridium

A

anaerobic, GPR

MC CO emphysematous cholecystitis

MC CO gas gangrene

tx- PCN, clinda 2nd line

323
Q

Light’s criteria

A
  1. PL protein/serum Pr >.5
  2. PL LDH/serum LDH > .6
  3. PL LDH > 2/3 ULN
324
Q

Tx of psuedocyst

A

<6cm and <6w –> conservative

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

325
Q

Arterial content

A

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

326
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

327
Q

FAP screening and treatment

A
  • Scopes annually starting at 10-12y
  • life-long screening for APC carriers.
  • Can stop at 40 if not APC carrier

Indications for colectomy

  • Suspected colorectal cancer
  • Severe symptoms
  • High-grade dysplasia
  • Multiple adenomas larger than 6 mm
  • Marked increases in polyp number on consecutive exams
  • Inability to adequately survey the colon because of multiple diminutive polyps
328
Q

Stewart-Treves syndrome

A

post mastectomy lymphangiosarcoma

rare and highly malignant

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

329
Q

Fibrinogen

A

binds gp2b/3a receptors to link PLTs together

330
Q

Ranson’s criteria at 48 h

A

“C and Hobbs”

  1. Ca < 8
  2. HCT down > 10 pts
  3. O2 < 60
  4. Base deficit > 4
  5. BUN > 5
  6. Sequestration of fluids > 6L
331
Q

Hemangioma

A

path- PERIPHERAL ENHANCEMENT

tx- if rupture, size change, or KM syndrome

332
Q

Drainage of gonadal veins

A

R- IVC

L- L renal vein

333
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

334
Q

Indications of breast MRI

A
  • high risk women
  • occult breast cancer
335
Q

T staging for esophageal cancer

A

t1a- muscularis mucosa

t1b- SM

t2- muscularis propria

t3- adventitia

*no serosa

336
Q

Halothane

A

cheapest

effective at low concentration

s/e- ventricular arrhythmia, hepatic necrosis

337
Q

Stress induced gastritis

A

Stress elevated ACh

ACh –> parietal cells –> ATPase H+ secretion

338
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

339
Q

Tx of Zenkers

A

<2cm: circopharyngeal myotomy

2-5 cm: myotomy +/- diverticulectomy

>5cm: myotomy + diverticulectomy

340
Q

Liver collection tx

Pyo-

Amoebic-

Echino-

A

Pyogenic- drain and abx

Amoebic- metronidazole

Echinococcal- albendazole and resect

341
Q

AT3 def

A

AD

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

tx- FFP

342
Q

Fibrolamellar HCC

A

well circumscribed w/ central scar similar to FNH

normal AFP and elevated neurotensin (Vs. FNH)

343
Q

Warfarin

A

competitive inhibitor of epoxide reductase (vit K activator)

344
Q

Human bite tx

A

amox/clavulanate (augmentin)

MC for human bites- eikenella

345
Q

Variceal bleeding after distal pancreatectomy

A

Gastric varices

346
Q

NNT

A

1/ARR

ARR = risk w/ tx - risk w/ placebo

347
Q

Surveilance schedule for FAP, HNPCC

A

FAP- start at 10

HNPCC- start at 20

348
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

349
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

350
Q

Mechanical valve periop

A

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

351
Q

Vitamin D processing

A

7-DHC + sunlight –> d3

liver –> 25-d3

kindey –> 1,25-d3

352
Q

Requirements for lung surgery

A
  • FEV1 > 1.5L (lobectomy), > 2L pneumonectomy
  • pppo FEV1 > 40%
  • ppo DLCO > 40%
  • VO2max > 15
353
Q

TRAM flap

A

SUPERIOR epigastric artery can use ipsi or contra muscle

354
Q

Normal values: CVP, WP, SVR, CI

A

CVP 2-6

WP 4-12

SVR 700-1500

CI 2.5-4

355
Q

Loop diuretics vs. Ca sparing diuretics

A

loop- furosemide

Ca sparing- thiazides

356
Q

Indications for chemo with breast cancer

A

> 1cm

Cx positive nodes

Triple negative

Poor oncotype

357
Q

TLV

A

TLV = RV + ERV + TV + IRV

FRC = RV + ERV

IC = TV + IRV

358
Q

VIPoma

A

Loc: distal

Px: watery DRH, hypoK, achlorhydria, inhibits gastrin

359
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

360
Q

Neoinitmal hyperplasia

A
  • proliferation and migration of vascular smooth muscle cells primarily in the tunica intima, resulting in the thickening of arterial walls and decreased arterial lumen space.
  • cause of restonisis after CEA
361
Q

Benign lesions that require excisional bx

A
  • Atypical DH/LH
  • LCIS/DCIS
  • radial scar
  • papillary lesion
  • any atypia
362
Q

MC nerve injury Br/Bac fistula

A

medial brachial cutaneous n.

363
Q

Pyloric stenosis

A

px- hypochloremic, hypokalemic metabolic alkalosis

dx- US

tx- pyloromyotomy

364
Q

Treatment of SVT

A

Vagal maneuvers or adenosine

365
Q

Fuel for colonocytes

A

SCFA (acetate, butyrate, propionate)

366
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

367
Q

Zone injuries

A

penetrating:

  • zone 1-3 –> explore

blunt:

  • zone1 –> explore
  • zone 2-3 –> do not explore
368
Q

Wiskott-Aldrich Syndrome

A

X-linked

TCPenia + combined b/t cell def + eczema

369
Q

hot vs cold nodules

A

hot- surgery or iodine ablation

cold- FNA

370
Q

TTP

A

path- def in ADAMtS13

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

tx- plasmapheresis → splenectomy if failed

371
Q

Layers of mucosa

A

Epithelium

Lamino Propria

Muscularis mucosa

372
Q

What is not suppressed by high dose dexa

A

Adrenal mass

Ectopic mass (small cell cancer)

373
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

374
Q

Enzymes secreted in their active form from pancreas

A

Amylase/Lipase

Ribonuclease/Deoxyribonuclease

375
Q

Gastrinoma

A

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

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

376
Q

dx of colovag and colovesic fistula

A

colovag: tampon test
colovesic: CT scan

377
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
378
Q

Milrinone

A

PD inhibitor

contractility with vasodilation

great for pulmonary hypertension

379
Q

HNPCC inheritance - Amsterdam criteria

A

AD

Defect in MLH/MSH

  1. 3x relatives
  2. 2x generations
  3. 1x < 50y
380
Q

Richter’s hernia

A

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

381
Q

Plasmin

A

degrades fibrin and fibrinogen

activated by urokinase and streptokinase

382
Q

HNPCC screening and treatment

A
  • scope q1-2y starting at 20-25
  • Surgery if: CRC or endoscopically unresectable
  • TAC with IRA and surveillance rectum
  • prophylactic hysterectomy and BSO offered at the time of colectomy
  • Other screens:
    • Annual pelvic exam, endometrial bx, TVUS
    • Upper endoscopy with bx of antrum. treatment of H. pylori infection
    • Annual urinalysis
    • Annual skin/neuro exams
383
Q

Melanoma types

A

superficial spreading- MC

lentigo- sun exposed, best prog

nodular- worst prog

384
Q

Replaced R and L hepatic

A

R- SMA

L- left gastric

385
Q

RQ of fat, carb, and protein

A

Carb = 1

Protein = .8

Fat = .7

386
Q

RR vs. OR

A

RR: of those who were exposed how many got the dz/of those who were not exposed how many got the dz

  • considers total population. good for prospective

OR: odds of exposure in cases / odds of exposure in controls

(a/c) / (b/d)

  • good for retrospective
387
Q

Encapsulate organisms

A

Strep pneumo (MC)

Neisseria

Haemophilus

388
Q

MMF

A

MOA: cell cycle inhibitor

389
Q

Immunonutrients

A

Glutamine

Arginine

Omega-3 FA

390
Q

Gail model

A

age

age 1st period

age 1st birth

1d relative

previous bx

race

391
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

392
Q

Origins of medullary thyroid cancer

A

4th pharyngeal arch releases NCC which form parafollicular C cells

393
Q

Bile Acids

A

750 cc/day secreted

Primary bile acids- cholic, chenodeoxycholic

Secondary bile acids- deoxycholic, lithocholic

primary bile acids produced by the liver then undergo deconjugation in the gut by bacteria.

394
Q

Component separation

A

External oblique fascia

395
Q

VHL

A

up regulation of vegf

hyper vascular tumors

396
Q

Felty syndrome

A

rheumatoid arthritis, splenomegaly, granulocytopenia

397
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

398
Q

Aminocaproic acid

A

Plasmin inhibitor

Use: DIC, excess tpa

399
Q

Secretin vs. CCK

A

Both released by duo

S cells –> Secretin- duct cells –> bicarb

I cells –> CCK- acinar cells –> enzymes

400
Q

Nutcracker eso

A

high amplitude/long peristalsis

normal LES pressure

normal relaxation

401
Q

Ectopic parathyroids

A

superior parathyroids is the tracheoesophageal groove and retroesophageal region.

inferior parathyroids- anterior mediastinum, thymus, thyroid gland

402
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

403
Q

Inidications for non-op managemement of eso perf

A
  • early diagnosis or delayed diagnosis with contained leak
  • not in the abdomen
  • contained perforation in the mediastinum
  • content of the perf drain back to the esophagus
  • perforation does not involve neoplasm or obstruction of the esophagus
  • absence of sepsis
404
Q

Treatment of GB polyp

A

Sxatic –> resect

High risk or > 6mm –> resect

Low risk –> EUS

> 18 mm –> open cholecystectomy, partial liver resection, and possible lymph node dissection

Gallbladder polyps that are not resected should be followed-up with serial ultrasound examinations

405
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

406
Q

z11 trial implications

A

If less than 3 nodes positive on SLN and T1 or T2 disease, BCT is OK

407
Q

Splenic vein thrombosis

A

If variceal bleeding tx with splenectomy

408
Q

Cervical neoplasia

A

CIN1- tx infection, close f/up

CIN2- cryo or leep

CIN3- cryo or leep

409
Q

McVay repair

A

Hernia repair without mesh

Approximates TAA to cooper’s ligament

410
Q

GCS motor

A

6- obeys commands

5- localized

4- w/draws

3- flexion (decort)

2- extension (decerebrate)

1- none

411
Q

Minimum negative margin for BCC

A

4 mm for unaggressive

8 mm for aggressive tumors

412
Q

CO2 vs. NO2 for pneumoperitoneum

A

CO2 advantage

  • doesn’t combust. less expensive.

CO2 disadvantage

  • acidosis, long elimination, sympathomimetic
413
Q

Mattox maneuver

A

“L –> Mattox”

move left structures to the right

exposure left sided vasculatre

explore aorta and L renal vein

414
Q

Propofol

A

Rapid distribution and on/off

s/e- hypotension, resp depression, meta acid

metabolism- liver

415
Q

Pancreas drainage procedures

A

Peustow- pancreaticojej (for large duct)

Frey- pancreasticojej + core out head

Berger- pancreatic head resection (for large head)

416
Q

Recurrent laryngeal nerve

A

motor to larynx excluding circothryoid injury: hoarsness, airway compromise

417
Q

Cryo used to treat?

A
  1. VWD
  2. Fibrinogen def
  3. Hemophilia A
418
Q

Tx for DVT

A

unprovoked: no RF –> 3-6m acoag
provoked: RF –> 3m

open thrombectomy –> last resort for threatened limb loss secondary to extensive DVT and phlegmasia

419
Q

Contents of FFP and Cryo

A

FFP: all clotting factors; f5 and 8 decrease over time

Cryo: VWF, f8, fibrinogen

420
Q

Ureter anatomy

A

Runs under the vas/uterine arteries

Runs over the iliacs

421
Q

Trauma to the pancreas

A

head

  • main duct: drain w/ staged resection
  • tail: drain

tail

  • main duct: drain
  • tail: resect w/ splenectomy (unless child)
422
Q

Central venous O2 vs. mixed venous O2

A

Mixed venous: from PA

Central venous: from SVC only (estimation of mixed)

423
Q

Exposing the pancreas

A
  1. Head: kocherize
  2. Body: incise gastrocolic ligament –> lesser sac
  3. Tail: mobilize spleen
424
Q

Cuff size for kids

A

age/4 + 4

425
Q

Crystalloid and colloid for trauma kids

A

Crystalloid: 20cc/kg

PRBC: 10cc/kg

426
Q

qSOFA score

A

AMS (<15)

RR > 22

SBP < 100

427
Q

Nitrogen balance

A

Nitrogen Balance =

Protein intake (grams)/6.25 - (UUN + 4 grams)

UUN = grams of nitrogen excreted in the urine over a 24 hour period

4 = stool and insensible losses

428
Q

s/e of carb, protein, and lipid

A

carb- immunosuppression, resp failure

lipid- pro inflammatory

protein- false neurotransmitters, rise in ammonia/urea

429
Q

Serum osm calculation

A

2xNa + Glu/18 + BUN/2.8

430
Q

Corrected Ca

A

For every 1 drop in albumin below 4, serum Ca drops by .8

431
Q

Acid/Base of Ng suctioning

A

HypoCl, HypoK metabolic alk

Loose HCl and fluid

Turn on RAA system

Retain Na/Excrete acid (paradoxic acidurea)

432
Q

Acetazolamide

A

MOA: Ca inhibitor

Causes kidneys to excrete bicarb causing a metabolic acidosis

433
Q

Ileal conduit

A

Hyperchloremic metabolic acidosis

(urine high in Cl is exchanged for bicarb which is excreted)

434
Q

MC ST sarcoma and dx and tx

A

MC- malignant fibrous histiosarcoma then liposarcoma

dx- core needle then –>

  • <4cm: excisional
  • >4cm: long. incisional

tx- resection. post op xrt if > 5cm. pre op if > 10cm. doxorubicin.

435
Q

Penecillins evolution

A
  1. Penicillin: strep
  2. Methicillin, Oxacillin, Nafcillin: staph
  3. Ampicillin, Amoxacillin: enteroccocus
  4. Unasyn/Augmentin: GNRs (not psuedo)
  5. Ticarcilin/Piperazillin: pseudomonas
436
Q

peri-op anti-PLT therapy in pt with stent/PCI

A
  1. No CV dz: stop ASA 7-10 days before surgery. Restart after 24-72h depending on bleeding in surgery
  2. Known CV dz
    1. Elective surgery: delay surgery until after optimal time
    2. Emergent surgert: c/w DAPT unless high bleeding risk

Dual antiplatelet therapy duration: post-pone elective operations

  • two weeks after simple dilatation
  • six weeks after bare-metal stents
  • 12 months after drug-eluting stent
437
Q

Acute cholangitis

A

Dx: U/S showing dilation > 7mm w/ jaundice, fever, RUQ pain

Tx:

  1. Mild and responding to abx: ERCP w/in 72h
  2. Severe and non responding: ERCP w/in 24h
438
Q

Relative c/i to componenet separation

A
  • Extensive destruction of the components of the abdominal wall
  • Compromise of the superior epigastric artery and/or deep inferior epigastric artery,
  • Contaminated operative field
  • Smoking, COPD, DM, ascites
439
Q

Stimulates pancreas from the jejunum

A

CCK

Secretein

GIP

440
Q

MYH gene

A

MYH associated polyposis

AR!

441
Q

Cryoptococcus vs. Coccidiomycosis

A

Crypto- CNS sxs in AIDs pt; tx- amphotericin

Coccidio- pulm sxs in the southwest; tx- amphotericin

442
Q

hypokalemia on EKG

A

ST depression.

T wave inversion

Prominent U waves

Long QU interval

443
Q

Rectal cancer work-up

A
  • complete scope: look for synch lesion
  • CT CAP: mets
  • T staging: rectal US (early stage), MRI (late stage)
444
Q

REY GB with choledocho

A

Trans-gastric ERCP

or double balloon endoscopy

445
Q

dx of ischemic colitis

A

endoscopy (although CT should be your first test)

446
Q

SIADH tx

A

acute- vaptans

chronic- h2o restriction, diuresis

447
Q

Breast abscess that fails to resolve after 2 weeks

A

Excisional bx to rule out inflammatory cancer

448
Q

Sarcoma prognosis by grade

A

1-

449
Q

Tx for ectopic pregnancy

A

Stable – methotrexate or salpingotomy

Unstable – salpingectomy

450
Q

Tx ARDS

A

TV at 4-6 ml/kg

Permissive hypercapnia

P/E < 200 –> high PEEP

P/E < 300 –> prone, nm blockade,

451
Q

Pitfalls of hiatal hernia repair

A
  • Left gastric artery along right crus
  • Abberant left hepatic artery in the gastrohepatic ligament
  • vagus nerve
452
Q

MEN genes

A

1- MENIN

2- RET

453
Q

Dx of:

Insulinoma:

Gastrinoma:

Glucagonoma:

VIPoma:

Somatostatinoma:

A

Dx of:

Insulinoma: insulin to glucose ratio > 0.4 after fasting; ↑ C peptide and proinsulin

Gastrinoma: serum gastrin > 1000 or SS test

Glucagonoma: gasting glucagon level

VIPoma: high VIP and dx of exclusion

Somatostatinoma: fastin somatostatin level

454
Q

Incidentally found Meckel’s

A
  1. Child and young adult- resection of the normal-appearing Meckel’s diverticulum
  2. healthy, young adults (<50 years of age)- resection of the normal-appearing Meckel’s diverticulum if there is a palpable abnormality or longer than 2 cm
  3. >50 years of age, and patients with significant comorbidities- not resecting
455
Q

Chemo drh

A

loperamide –> octreotide

consider c. diff testing if copious or resistant

456
Q

Choledochol cyst epidemiology

A

females and asians

15% get cholagioncarcinoma

457
Q

Tx of desmoid tumors

A

Women, benign but locally invasive; ↑ recurrences

Gardner’s syndrome

Painless mass

Tx: wide local excision if possible; if involving significant small bowel mesentery, excision may not be indicated → often not completely resectable

Medical Tx: sulindac and tamoxifen

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