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zAbsite Final 2019 > True Learn Absite - 2020 COPY > Flashcards

True Learn Absite - 2020 COPY Flashcards

1
Q

Indications for ppx abx for SBP

A

GI HMHG, low protein ascites (< 15 g/L), hx of SBP

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2
Q

Tx desmoid tumor

A

WLE

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3
Q

Tx mesenteric cyst

A

enucleation

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4
Q

Tx appendicitis

A

Perforated w/ abscess → drain and tx medically
Perforated w/out abscess → medical management or OR; no consensus
Non-perforated → lap appe

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5
Q

Indications for local excision of rectal cancer

A

< 3 cm, <30% circ, mobile, no nodes, SM only, no high risk histo

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6
Q

Tx with least incontinence for anal fissue

A

LATERAL, INTERNAL sphincterotomy

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7
Q

Treatment of anal melanoma

A

WLE (DO NOT respond to chemo-XRT)

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8
Q

Tx melanoma

A

resect w/ proper margin, avoid Mohs, resect palpable/SLN+

goal to resect nodes (not stage)

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9
Q

Tx of rectal abscess

A

supralevator- transrectally

all others- drain to the skin

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10
Q

Tx of HMHD

A

1-2: sclerotherapy, infrared coag
2-3: rubber band ligation
3-4: HDHD’ectomy (less recurrence), stapled HMHD’pexy (less painful)

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11
Q

HMHD grading

A

1- bleeding, 2- prolapse w/ spon reduction, 3- prolapse w/ manual reduction, 4- irreducible

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12
Q

condyloma types

A

acuminatum- HPV ( 6, 11- benign; 16, 18- Ca)

lata- syphilis

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13
Q

Anal verge
Anal margin
Anal canal

A

Anal verge: separates anal canal/anal margin. hair bearing to non hair-bearing; ext anal sph ends
Anal margin: below anal verge
Anal canal: above anal verge

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14
Q

Tx of High grade AIN/bowen’s disease of anal margin

A

lifetime surveillance even if tx!; excise if > 3cm, sxatic, atypical

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15
Q

Tx of SqCC of anal margin

A

tx like SqCC of the skin

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16
Q

Tx SqCC of anal canal

A

Nigro protocol- RTx (of Ca + inguinal/pelvic nodes) + 5FU + MitoC; Recurrence- APR
SqCC equivalents- large cell ker. (SqCC), transitional zone, LCl non-ker, basaloid, mucoepidermoid

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17
Q

Tx Melanome of anal canal

A

unresponsive to chemo-RT; 5y-S is 20% w/ R0; WLE = APR

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18
Q

Tx of Thrombosed external HMHD

A

w/in 48h- excision

after 48h- medically manage

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19
Q

Tx of rectal prolapse

A

rectopexy (presacral facia) + sigmoidectomy if const’n/slow transit
old/sick- perineal

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20
Q

Tx of anal fissure

A

itz/fiber; chronic- add nitro/dilt; failed medical- lateral internal sphincterotomy

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21
Q

Tx anal incontinence

A

1st line- fiber/bulking, exercises

refractory- overlapping sphincteroplasty

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22
Q

Tx of Pilonidal cyst

A

leave open!; midline- longer healing/lower recurrence; off midline- less comps (preferred)

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23
Q

Tx of CBD stone intraop

A

transcystic/transductal (larger stones) lap bile duct exploration; ERCP if unable

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24
Q

PSC

A

M; intra/extra hepatic; onion fibrosis; chain of lakes; a/w UC, cholangioca; tx- trx, cholesty., UDCA

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25
Q

PBC

A

F; intra hepatic; granulomas; +AMA; a/w Sjogren, RA; tx- trx, cholesty., UDCA

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26
Q

Tx for cholangiocarcinoma

A

Upper ⅓ (Klatskin): lobectomy and stenting of contra lobe; consider neoadj + trx if unresectable
Middle ⅓: hepaticojejunostomy
Lower ⅓: pancreaticoduodenectomy (Whipple)

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27
Q

Strasburg classification of bile duct injuries

A 
A- leak
B- ligation of aberrant R hepatic
C- transection of aberrant R hepatic
D- lateral injury to major duct
E- complex injury with complete bile duct transection
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28
Q

Replaced hepatics

A

R hepatic: posterior to cystic duct; off of SMA

L hepatic: within hepatogastric ligament; off of L gastric; medial to portal triad

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29
Q

CBD exploration techniques

A

transcystic- small stones or large CD
transductal- large stones or small CD
Leave T-tube- avoid spasm and back pressure that could blow out your stump

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30
Q

Lap chole w/ intraop choledocho

A
  1. Saline flush, 2. Glucagon, 3. Lap CBD exploration (TC or TD)
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31
Q

Tx CO poison

A

1st 100% 02 NRB, then hyperbaric O2 (most effective); intubate if comatose, severe acidosis

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32
Q

Tx thoracic eschar

A

early intubation then escharotomy along ant. ax lines (b4 CT)

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33
Q

Burn degrees

A

1D: red without blisters
2D superficial: papi dermis; blisters; most painful; blanches +hair; no surg
2D deep: red/white; ret dermis; mild pain; no blanch; surg if not healed >3w
3D burn: white/waxy; leathery skin; insensate; early surg/graft
4D: fat/muscle/bone; surg

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34
Q

Tx of Hypothermia

A

Mild- <94: shivering, AMS; tx- passive ext (remove wets, blankets)
Moderate- <89: combative, mydriasis, afib; tx- active ext (warm blankets/air/bath)
Severe-<84/29: long QRS, osborne waves, VFib; coma; tx- active int (warm O2/IVF, bypass/lavage)
Profound-<70: loss of vital signs, cardiac activity, EEG; tx- ACLS, active internal

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35
Q

Tx of freezing

A

Frostnip: ice crystal on skin; pain, numbness; tx- rewarming
1D frostbite: frozen below skin; numbness/edema; firm plaque; tx- 1-2 wks to heal
2D frostbite: milky white blister; tx- 2-4 wks to heal
3D frostbite: hemorrhagic blister; tx- 3m to heal
4D frostbite: bone; black mummified tissue;

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36
Q

Parkland Formula

A

4 x TBSA x wt; ½ in 1st 8 hours; modified Brook’s formula: use 2 instead of 4

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37
Q

Rule of 9s

A

ant/post C/A-18 each; ant/post leg-9 each; ant/pos arm- 4.5 each; H/N- 9; genital-1

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38
Q

Indication for APR

A

w/in 2cm of anal verge (levators), baseline sphincter dysfxn, recurrent SqCC (s/p Nigro)

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39
Q

Tx GIST

A

resect ALL (any size) w/ -MICRO margin
Imatinib post op if C-Kit+
neoadj if inoperable

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40
Q

FAP Tx

A

TAC w/ IRA→ q1y scope post op → polyposis/high grade dysplasia @ stump → proctectomy +/- pouch

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41
Q

Elective UC Tx

A

TAC w/ IJP; indications- ANY dysplasia, refractory
incontinence is a c/i
Surgery reduces: erythema nodosum, arthritis; no effect on PSC!

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42
Q

Hinchey

A

1- pericolic abscess, 2- pelvic abscess, 3- purulent, 4- feculent; scope 6-8w post dc

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43
Q

Neoadjuvant therapy related to T stage

A

esophagus- t1b+, stomach- t2+, colon- t4b, rectum t3+

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44
Q 
LN harvest/margin
eso
stomach
colon
rectum
A

eso- 15/7cm
stomach- 15/5cm
colon-12/5 cm
rectum- 12/5 cm

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45
Q

APC gene

A

chrom5; mc mutation in colon ca; 1st mutn in adenoma to carcinoma; a/w FAP

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46
Q

Lynch Syndrome

A

DNA mm repair- MLH1, MSH2/6, PMS2
scope @ 25 or 10yrs before relative
any ca → TAC IRA

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47
Q

Infliximab

A

monoclonal Ab to TNF

use- moderate crohns, recurrent perianal fistula!

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48
Q

Sulfasalazine/5-ASA

A

COX/LOX inhibitor
suppress inflammation
quiescent crohn’s

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49
Q

Azathioprine/6-MP

A

inhibit DNA synthesis

immunosuppression by blocking Cyto T and NKC

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50
Q

MEN 2A

A

RET gene

thyroidectomy b4 5 (age 2 for 2B)

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51
Q

Mucinous cystic neoplasm

A

malig potential; viscous, “string like”
high CEA, low Amylase
tx- resect

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52
Q

Cystadenoma

A

serous aspirate
low CEA, low Amylase
tx- resect if sxs

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53
Q

IPMN

A

high CEA, high amylase
in communication w/ panc duct
main vs. branched

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54
Q

Pseudocyst

A

low CEA, high amylase

tx- wait 6 weeks then drain or resect

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55
Q

Von Hippel Lindau

A

VHL gene
upreg. of VEGF
CNS/retinal hemangioblastoma, clear cell RCC, pheo

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56
Q

Li Fraumeni S

A

breast cancer, soft tissue sarc

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57
Q

Esophagus blood supply

A

Cervical- inf thyroid
Thoracic- aortic branches
Abd- L gastric/inf phrenic

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58
Q

Heller myotomy margins

A

5cm proximal, 2cm distal

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59
Q

DeMeester score

A

pH <4 , changes in position, duration, # of episodes; > 14.7 is positive

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60
Q

Eso dysplasia tx

A 
LGD- scope q6-12m lifetime (even if fundoplication)
HGD- ablation + Q3m scope
T1a- ablation
t1b- esophagectomy
*Fundop does not decrease cancer risk
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61
Q

Fundoplications

A

dor- ant 200
toupet- post 180
belsey/mark IV- transthoracic ant 270

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62
Q

GERD alarm sxs

A

wt loss, early satiety, blood, dysphagia, odynophagia → EGD

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63
Q

Zenker’s tx

A

left C incision; cricopharyngeal myotomy + staple channel (large) or diverticulectomy (small)

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64
Q

Tx acute variceal HMHG

A

octreotide + antibiotics → endoscopic intervention (ligation/sclerotherapy) → TIPS

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65
Q

Transhiatal esophagectomy

A

C+A incision

gastric conduit supply- R gastroepiploic (off GDA/CHA)

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66
Q

DES tx

A

CCB (+TCA if chest pain) → botox; surgical management is last resort

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67
Q

Corrected Ca

A

[0.8 x (4 - patient’s albumin)] + serum Ca level

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68
Q

Metabolic alk

A

Cl responsive- temporary loss, replaceable
- vomiting
Cl resistant- hormonal, continuous loss
- conn’s, steroids, hyperaldosterone

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69
Q

Serum osmolarity

A

Osm = 2xNa + Glu/18 + urea/2.8

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70
Q

MC etiology of ESRD leading to kidney trx

A
  1. DM, 2. HTN, 3. PCKD
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71
Q

AG

A

Na - (Cl+Bic)

NaCl = non-AG, metabolic acidosis

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72
Q

Ferritin

A

storage, intra/extra cellular

low in IDA/high in ACD (2/2 inflammation)

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73
Q

Tumor lysis syndrome

A

hyperU, K, Ph w/ hypoCa; CaPh crystal—> renal failure + hypoCa

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74
Q

Vit D vs. PTH

A

Vit D: increase Ca and Ph

PTH: increase Ca and decrease Ph

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75
Q

4-2-1 rule

A

4 cc/kg/hr for 1st 10 kg, then 2 for 10-20 kg, then 1 for everything above 20

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76
Q

Free water def

A

.5/.6 x kg x (Na - IdealNa)/(IdealNa)

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77
Q

Sodium def

A

.5/.6 x kg (Na ideal - Na)

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78
Q

Rectovaginal fistula tx

A

wait 3-6m; low- endorectal advancement flap; high- abdominal approach

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79
Q

Tx of cervical ca

A

conization/LEEP for 1a; primary chemoRT, brachytx B4 surg

pelvic/aortic LN’s

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80
Q

Tx of endometrial ca

A

TAH+BSO, peritoneal w/o (for cytology), LN sampling

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81
Q

TRALI

A

DONOR Ab attacks recipient WBC

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82
Q

ADP antagonists

A

clopidogrel, prasugrel, ticagrelor (reversible)

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83
Q

TXA2 antagonist:

A

ASA (via Cox-1); irreversible

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84
Q

Reversible DTA:

A

dabigatran

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85
Q

tx VWD

A

tx- DDAVP (ineffective for t3), cryo

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86
Q

Tx ESRD PLT dysfxn

A

2/2 uremia; tx w/ desmo; cryo 2nd line; don’t use PLTs → become dysfxn

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87
Q

Consider bridging if

A

troke/TIA w/in 1 month, mechanical valve, high CHADS-VASC

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88
Q

Acute hemolytic trx reaction

A

rapid RBC destruction by host IgM/IgG

+direct coomb’s

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89
Q

Amphotericin

A

antifungal
lipid soluble- penetrates CNS
↑ s/e- hypoK/Mg, hepatotoxic, anemia, arrhythmia

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90
Q

HS reactions

A 
1- IgE mediated; allergic rxn
2- aB mediated rxn
3- immune cx; ex- serum sickness
4- delated; t-cell mediated
5- auto-immune
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91
Q

IF-gamma

A

NKC, macrophage activation

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92
Q

TGF-B

A

inhibits T-cell activation

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93
Q

Tx liver lesions

  • Hemangioma
  • FNH
  • Adenoma
A
  • Hemangioma: resect if sxs
  • FNH (+kuppfer): resect if sxs
  • Adenoma (-kuppfer): <5cm- stop OCP, observe; > 5cm- resect
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94
Q

Functional Liver Remnant

A

minimum 20% if normal liver; pre-op chemo/some dysfxn = 30%; cirrhosis = 40%

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95
Q

Tx and dx of SBP

A

3GC abx AND albumin (survival benefits)

dx- ↑ascitic PMN and + culture;

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96
Q

Sorafenib

A

TK inhibitor; tx of HCC

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97
Q

Tx of liver abscess:

  • fungal:
  • hydatid cyst:
  • amoebic:
  • pyogenic
A
  • fungal: perc drain + micafungin (ampho is 2nd line)
  • hydatid cyst: albendazole qwks then drain
  • amoebic: metronidazole
  • pyogenic:
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98
Q

Indications for trx

A

ALF- INR > 1.5

CLF- MELD >=15, INR > 1.5

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99
Q

Enterohepatic circulation

A

Liver → P BSalts → hepatocytes → conjugated BS → 80% active ileum absorbed
20% deconjugated by bacteria → passive colon absorbed; 5% out in stool

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100
Q

Maneuvers

A

Kocher- lateral peritoneal attachment of D2
Maddox- white line from sig to splenic flex
Cattell- continuation of kocher; from D2 to sigmoid

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101
Q

Tx of GB polyps

A

surg if- any size w/ lithiasis, > 1cm

< 1 cm w/out stones can observe

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102
Q

Tx of pancreatic necrosis

A

ICU, fluid, pain meds → MRCP (no cholangitis) or ERCP (cholangitis) → delay OR
If evidence of fluid infection (w/out cholangitis): proceed with CT guided drain placement

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103
Q

S/e of trx meds

  • Tacro
  • Azathioprine
  • Mycophenolate
  • Sirolimus
A
  • Tacro: neuro sxs (tremor), neph’tox, HTN, alopecia, hyperK, hypoMg, GI sxs
  • Azathioprine: marrow suppression, leukopenia, hep’tox, pancreatitis, pulm fibrosis
  • Mycophenolate: GI sxs, leukopenia
  • Sirolimus: hypterTG, impaired wound healing,
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104
Q

Wt loss/surgery

A

lap band 50-55
sleeve 55
REY 60
Duo switch 70

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105
Q 
Mineral def:
Zn
Sel
Chromium
Copper
A

Zn- wound heal/skin
Sel- cardiomyopathy
Chromium- hyperglycemia
Copper- micro anemia

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106
Q

B1 def:

A

cardiomyopathy, wernicke’s encephalopathy, p. Neuropathy

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107
Q

T1/2 albumin vs. pre-albumin

A

Albumin- 20 days, prealbumin- 2 day

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108
Q

N balance

A

(protein intake/6.25) - (protein in urine + 2); 6.25 = g of N/g of P
2 = insensible loss

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109
Q

Cori cycle

A

recycling of lactate and pyruvate for gluconeogenesis

provides 40% of glu when starving

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110
Q

Gluconeo precursors

A

lactate , pyruvate, AA

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111
Q

UE Injuries

A

supracondylar humerus- brachial a
DRF- median n
ant shoulder disloc’n- ax. n
post shoulder disloc’- ax. a

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112
Q

LE injuries

A

post hip disloc’n- sciatic n. (peroneal branch)

post knee disloc’n- popliteal a.

113
Q

Interossei innervation

A

palmar- ulnar n, adduct
dorsal- ulnar n, abduct
lumbricals- median (1-2)/ulnar (3-4)

114
Q

Pancreatic mucinous lesions

A

Pseudocyst- high Am, low CEA, KRAS neg
Serous cystadenoma- low Am, low CEA, KRAS neg
MCN- low Am, high CEA (>200), KRAS pos
IPMN- high Am, high CEA (>200), KRAS pos

115
Q

Tx pseudocyst/WON

A

wait 4wks; < 6cm- NTD (unless sxs); >6cm and asx- NTD; > 6cm and sxs- drain
attempt endoscopic 1st; near stomach/duo- cystenterostomy; otherwise REY cystojej

116
Q

Tx infected pseudocyst

A

aspirate/gram stain to dx → drainage (internal, external, endoscopic)

117
Q

Tx Infected panc necrosis

A

stable- wait 4 weeks, IR retroP drain; unstable- debride

Debride: VARD (video-assist retroP)- utilize retoP drain, DEN (endoscope), open necrosectomy

118
Q

Infected pancreatic abscess

A

external drainage

119
Q

Step up approach

A

Infected panc necrosis

IR/endo drain → 2nd drain → VARD → lap necrosectomy

120
Q

Tx Panc fistula:

A

tx- NPO, TPN x 4-6 wks → ERCP w/ stent → surgery

121
Q

Blood supply panc:

A

tail pancreatic branches of splenic a, head- super PD (GDA/celiac), inferior PD (SMA)

122
Q

Atlanta classifications:

A

< 4w- acute pancreatic or necrotic collection; > 4w- pseudocyst or WON

123
Q

Tx Panc divisum

A

sph’otomy by cutting the minor papilla to enlarge the opening and allow pancreatic enzymes to flow

124
Q

Acute pancreatitis tx:

A

NPO + IVF; enteral feeds ASAP ( > TPN); NG or NJ; octreotide not useful

125
Q

PMN tx

A

Branched: resect- malig cells, mural nodularity, > 3cm; 1-3cm re-image q6m; <1cm- q1y
Main duct: resect- > 10 mm; 5-9 mm EUS/FNA; < 5mm- surveil

126
Q

Tx Serous cystic neo/cystadenoma

A

resect if > 4cm or sxs

127
Q

Tx mucinous cystic neo

A

resect all

128
Q

Puestow

A

kocherize duo, aspirate duct, split open duct 1-2 cm from duo to > 7 cm, REY panc-jej in 2 layers

129
Q

Whipple

A

resect panc head, duo, distal stomach; gastro-jej + panc-jej + hepatico-jej

130
Q 
Tx of pancreatitis masses
WON sterile
WON infected
Pseudocyst:
Infected pseudocyst
A

WON sterile: conservatively
WON infected: step up
Pseudocyst: tx if sxs (infxn, obstruction, pain); 4-6w → internal drain → cystenterostomy
Infected pseudocyst: drainage (internal, external, endoscopic)

131
Q

Tx Annular pancreas

A

duodenojejunostomy

132
Q

Melanoma characteristics:

  • mc
  • best prog
  • AA
  • worst prog
A
  • mc: superficial spreading
  • best prog: lentigo
  • AA: acral
  • worst prog: nodular
133
Q

Tx Actinic keratosis

A

topic 5FU. Photodynamics, imiquimod, cautery; no margin

134
Q

Staph species

A

G+/aerobe/clusters; coag+ → aureus

coag- → epidermidis

135
Q

Strep species

A

G+/aerobe/chains;
a hemo- pneumo, viridans
b hemo- GAS(pyo)/GBS(aga)
non hemo- enterococci

136
Q

Melanoma tx

A

MIS- 5mm; <1mm- 1cm; 1-2mm- 1-2cm; >2mm- 2cm; SLNBx

SLNBx: if > 1mm or if .75-1 mm w/ ulceration or high risk features w/ clinically negative nodes

137
Q

BSC tx

A

SLNBx- only if clinically palpable nodes; tx- WLE w/ .5cm margin

138
Q

Sarcoma prognosis

A

GRADE used for staging; more important size/depth, nodal/distal mets, mitosis count

139
Q

ITP vs. TTP tx

A

ITP- steroids (only if PLTs < 30k), splenectomy if unresponsive
TTP- plasmaphoresis

140
Q

Tx TCPenia

A

<10k if asx; <20k if septic, chemo/rads, RF’s; <50K if elective surgery

141
Q

Tx splenic echinococcal cyst

A

sterilize w/ etoh injection → splenectomy; opening could cause anaphylaxis

142
Q

Splenic vein thrombosis

A

px- gastric varices w/ normal portal p

tx- ppx splenectomy

143
Q

Vagotomies

A

truncal- transect ant/post @ distal eso

HSV- transect @ crow’s ft, preserve laterjet, no drainage

144
Q

Posterio and anterior vagal trunk branches

A

Posterior trunk- criminal nerve (post), celiac branch (ant), post laterjet
Anterior trunk- hepatic branch, ant laterjet

145
Q

Tx hiatal hernia

A

t1- PPI x 8-12w → surg

t2-4- repair all sxatic pts

146
Q

Duo vs. stomach ulcer

A

Duo ulcer: pain 2-3h after meal; 90% H. pylori, 10% NSAIDS

Stomach ulcer: pain right after meal; 75% H. pylori, 25% NSAIDS

147
Q

T3 ulcer: tx

A

pre-pyloric

antrectomy + Bile1/2 + vagotomy

148
Q

Gastric CA tx

A

neo-adj chemo for T2+ or N; proximal- total gastrectomy; distal- partial; 5cm margin; 15 nodes

149
Q

Barrett’s eso surveillance

A

no dysplasia- 4 quad every 2 cm q 3-5y

dysplasia 4 quad every 1 cm q 3-6m

150
Q

Minimum FEV1 for resections

A

pre-op → FEV1 > 2L- pneumo, >1.5L; post op: >.8 or 40% predicted

151
Q

SVC syndrome tx

A

stent, radx, steroids (no chemo/surg)

152
Q

Chylothorax tx

A

CT and NPO → 7d: thoracic duct lig

153
Q

Transudate

A

protein (pl/se) < .5, LDH (pl/se) < .6 or ⅔ ULN → CHF, pericarditis, cirhosis, nephrotic s

154
Q

Exudates

A

protein (pl/se) > .5, LDH (pl/se) > .6 or ⅔ ULN → AI, eso rupture, infxn, malig, pancreatitis, PNM

155
Q

EBUS accesible nodes:

A

2, 3, 4, 7, 10, 11, 12; innominate seperates level 3, 4; 7- sub-carinal; 10- R/L hilar

156
Q 
Trx drugs MOA
MMF
Cyclosporine
Azathioprine
Tacro
Sirolimus
A 
MMF: purine synthesis inhibitor
Cyclosporine: calc inhibitor
Azathioprine: purine synthesis inhibitor
Tacro- calc inhibitor
Sirolimus- mTor inhibitor
157
Q

Post trx lymphoproliferative disorder

A

B sxs; 2/2 EBV+ B cells; may cause l’oma

tx- reduice IS, rituximab

158
Q

Bladder ca tx

A

Ta/T1- no muscle, tx- trans-U resexn + transU BCG/mitoM

T2a- invasive, tx- cystectomy +/- chemo

159
Q 
Cause of stones:
CaOx
Uric Acid
Cysteine
CaPh
MgAmPh
A 
CaOx- diet
Uric Acid- protein
Cysteine- AA metab. error
CaPh- high pH
MgAmPh- urease infxn
160
Q

Stages of healing:

A

stasis (1-3d), inflammation (3-20), proliferation (1-6w), remodeling (6w-2y)

161
Q

Order of cells in healing:

A

PMNs (24-48h) → macro (48-96h) → lympho (3d) → fibro (10d)

162
Q

Fibroblasts

A

dominant cell during proliferation AND remodeling

163
Q

Inflammatory phase

A

macrophages are most important (phago + cytokines); PMNs come first

164
Q

Proliferative phase

A

neovascularization, collagen syntehsis; mphasges intially but fblasts dominant; HIF-1

165
Q

Stages of graft healing

A

imbibition (direct diffusion) → inosculation (cap beds meet) → revascularization

166
Q

Increased ETCO2

A

MC hypoventilation, atelectasis; malig hyperthermia, meta acid, hypermetab, pneumo

167
Q

c/i to epidural

A

high ICP, therapeutic acoag, AVM, HDUS

SQH- wait 4h; lovenox- wait 24h; ASA is not c/i

168
Q

Ketamine

A

not c/i with high ICP!
s/e- HTN, tachy
amnestic + analgesic; no resp depression

169
Q

Tx Post dural puncture headache

A

after epidural; tx with blood patch

170
Q

Tx fat necrosis

A

no trauma- bx

trauma- watch

171
Q

Tx Galactocele

A

dx/tx- aspiration; no tx if asxatic, continue bfeeding

172
Q

Tx Inflammatory breast ca

A

neoadj + surg + XRT

SLNBx c/i!

173
Q

Types of mastectomy

A

Simple/Total mastectomy: removal of all breast tissue, NAC, most of skin
BCT = partial mastectomy + XRT
MRM: removal of breast parenchyma, NAC, skin, and level 1-2 nodes

174
Q

LCIS Tx

A

surv + tamox OR bilateral l’omy; DUCTAL ca; no (-) marg

175
Q

Tx male breast ca

A

usually simple mastectomy w/ SLNBx; BCT usually can’t be done b/c not enough tissue

176
Q

DCIS tx

A

lumpectomy (2mm) + XRT +/- boost (no SLNBx)

if XRT c/i → mastectomy AND SLNBx

177
Q

Tx Phyllodes

A

WLE w/ 1mm margin

178
Q

Tx Malig BC in preg

A

1t- MRM
2/3t- lumpectomy, SLN (no blue dye), chemo (6w later),
RT post-delivery

179
Q

Breast nerves:

A 
TD- LD, ADduct
ICB- hypesthesia
LPN- p major
MPN- p major/minor
LTN- SA, wing scap
180
Q

Breast lesions that require bx

A

radial scar, any atypia, any invasive ca, vascular proliferations, discordant bx

181
Q

DCIS SLNBx:

A

not w/ l’omy unless >4cm, multicentric, palpable, high grade

required w/ mastectomy

182
Q

Thrombophlebitis (Mondor’s disease) tx

A

NSAIDS

183
Q

Intraductal papilloma dx and tx

A

MCCO bloody nipple dc
dx- contrast ductogram
tx- resection

184
Q

Mastodynia tx

A

cyclic 2/2 fibrocyst dz- OCP/NSAIDS

non-cyc + >30 OR cyclic + mass → mammo

185
Q

Breast abscess tx

A

US aspiration BEFORE I&D

I&D if refractory

186
Q

Dobutamine

A

B1 at low dose- inotropy

B2 at high dose- vasodilation

187
Q

Milrinone:

A

intotropy + vasodilate; PDEi→ decreased cAMP → SR Ca uptake

relaxes smooth muscle

188
Q

Arterial O2 content

A

(1.34 x Hb x SaO2) + (.003 x PaO2); Hb is most important factor

189
Q

tx for post pneumo empyema

A

Eloesser flap

190
Q

Tx SVT

A

vagal → adenosine
may unmask” afib/flutter; synch
Car’verison last resort

191
Q

qSOFA

A

tachypnea + AMS + SBP

192
Q

Tx Hypertrophic cardiomyopathy

A

avoid inotropes; use neo if needed

193
Q

Management of PE

A

no RH strain → acoag
RH strain → IR catheter
RH strain + HDUS → systemic tPA

194
Q

MC nosocomial infection

MC nosocomial ICU infection

A

MC nosocomial infection- UTI

MC nosocomial ICU infection- VAP

195
Q

Tx FMD

A

angio + balloon

196
Q

Tx acute limb ischemia

A

Tx: 1- hep gtt
2a- thrombolysis (sensation)
2b- surg (weakness)
3- amputation (paralysis)

197
Q

Tx RA stenosis

A

perc translumen angio; ACEi unless 1 kidney/bilateral dz

ACEi for renal HTN: dilate efferent arterial but reduce GFR

198
Q

DVT tx:

A

ileofemoral- cather directed thrombolysis; other- anticoagulation

199
Q

LE arteries:

A

CF → DF (70%) and SFA (30%); DF → cx, genicular, perforating; SFA → AT (DP), P, PT

200
Q

TXX Pop aneurysm

A

: >2cm- ligation and bypass; <2cm- observation; avoid stents

201
Q

TX for leriche s

A

bypass

202
Q

tx venous TOS:

A

2/2 repetitive exercise; tx- anticoag, thrombolysis → 1st rib/ant scalene resection wks later

203
Q

Tx Failure of maturation of AVF

A

fistulogram or arterio/veno gram → endovascular intervention → open

204
Q

Tx peripheral PsA

A

tx- compress 20m → thrombin; immediate surg- infxn, HDUS, pulsatile, skin changes, ischemia, AMS

205
Q

Tx Hemobilia after trauma:

A

EGD → CTA (if stable)

unstable- angio embolization (no surgery)

206
Q

Cilostazol:

A

tx for periph claudication; MOA- PDi, inhibits PLT aggregation; c/i in any degree of HF (PDi)

207
Q

Vertebral artery occlusion

A

posterior circulation sxs- dizziness, diplopia, dysphagia, dysarthria, ataxia

208
Q

Elective surg after DEStent

A

postpone for 6m, hold plavix 7d b4, c/w ASA; need plavix fat least 6m after DES

209
Q

TOS tx

A

neurogenic PT → rib resection, scalenectomy, BPlex dissection
Venous- catheter directed thrombolysis → surgical decompression
Arterial- C7/1r resection, subc artery resection/reconstruction

210
Q

Tx facial nerve inj

A

relative to lateral canthus of eye; medial- non op OK (arborization); lateral- OR!

211
Q

Tx Pelvic fx HDUS

A

binder, angio (OR packing if n/a), fixation; refractory bleed after angio → needs fixation

212
Q

Tx Neck trauma

A

OR if platysma violation + crepitus, odynophagia, pulsatile bleed, expanding h’oma, bruit, thrill
Non-op w/up: 4V angio, doppler or CTA, UGI (esophagography) or esophagoscopy, bronchoscopy

213
Q

Tx tracheal inj

A

ABSORBABLE in 1 LAYER w/ strap; large → tracheostomy, avoid below 3rd ring (TI fistula)
can perform primary repair up to 5-6 rings; must mobilize; large ant defect- tracheostomy

214
Q

LE vascular trauma

A

small- patch plasty
large- contralateral GSV
limited time/unstable- shunt

215
Q

Grading BCVI

A

anti-PLT + angio/OR if sxs; g4/5 require OR (no angio)

1- <25% narrowing, 2- > 25% narrowing, 3- PsA, 4- complete occlusion, 5- transection

216
Q

Ureter injury

A

prox- primary anastomosis
middle- transUU
distal- reimplant +/- psoas hitch

217
Q

Access supraceliac aorta

A

mattox maneuver → divide left crus → supraceliac clamp

218
Q

Indics for ED thorac

A

trauma with witnessed loss of vital but SOL

SOL = ECG activity, reflexes, GCS > 3

219
Q

Tx Odontoid fx

A

1- upper D, stable, non-op
2- base of D, unstable, worst, +/- surg
3- c2 vert, usually no OR

220
Q

tx Flank wound

A

HDS- CT w/ triple contrast (oral, IV, rectal)

HDUS- OR

221
Q

Tx Urethral injury

A

Grade: 1/2- contusion/stretch, cath
3- part disruption, OR
4/5-complete disruption, cystostomy + OR

222
Q

Tx Supra-renal aorta inj:

A

can’t resect (exposure); repair w/ (non-abs) polyprop; adj perfs connected/closed
Close defect transversely to avoid stenosis; if stenotic → patch angioplasty

223
Q

Tx DPGM injury

A

ABD approach, close w/ NAb

224
Q

Thoracotomy access

A

Right thoracotomy- mid esophagus and DISTAL trachea

Left thoracotomy- distal esophagus, left mainstem

225
Q

Tx congential DPGM hernia

A

prenatal dx on US; intubate (in delivery rm), NGT +/- ECMO → OR when stable

226
Q

Hernia repairs

A

Lichtenstein: mesh recreates the floor; inferior → shelving edge; medial → PT; super → TA/conjoint tendon
Bassilini: conjoint tendon to shelving edge recreates the floor
Cooper’s/McVay: conjoint tendon to cooper’s lig; needs relaxing incision; use for fem hernia!
Shouldice: 4-layer w/ 2 running sutures; no mesh; lowest recurrence

227
Q

Superior epigastrics

Inferior epigastrics

A

SE: runs posterior to rectus but anterior to posterior rectus sheath; branch of int mammary

IE: runs in pre perit space between transversalis fascia and parietal perit; branch of EI

228
Q

Umbo ligs

A

round- umbo v.
median- urachus
medial- umbo a
Omph/M- vitelline duct (Meckel’s)

229
Q

Tx Umbo hernia in child

A

most close by 2
<3cm- primary repair
>3cm- mesh; repair by 5

230
Q

Tx SB fistula

A

⅓ close
feed enterally unless high output (>500cc/day)
Consider OR at 12w

231
Q

Crohn’s stricture tx:

A

no surg hx- resct
prior surg + <10 cm- Heineke
10-20 cm- Finney
>20- S2S IsoP

232
Q

Stricturoplasties

  • Heineke s’plasty:
  • Finney s’plasty:
  • Side2Side isoperistaltic s’plasty:
A

Heineke s’plasty: ideal for <10cm; open long and close transversely
Finney s’plasty: ideal for > 10cm; structured segment folded on itself and common wall created
Side2Side isoperistaltic s’plasty: > 20 cm; overlap stricture/dilated area; 2x enterotomy/sew bowel together

233
Q

Tx maltoma

A

triple therapy

234
Q

Tx T cell SB lymphoma:

A

poor prog

tx w/ chemotherapy; surgery is palliative

235
Q

FAP Tx

A

scope q1y at 10; scope= 100+ polyps
100% r/o CRC, especially peri-ampula
offer ppx colectomy

236
Q

Lynch S Tx

A

HNPCC
scope q1y at 25
CRC by age 40

237
Q

Tx Meckel’s

A

base < 2 cm → diverticulectomy
> 2 cm → seg resection
do appe too

238
Q

Tx Mucinous neoplasm of appendix

A

confined to appendix/unruptured→ appe only; otherwise → R hemi

239
Q

Tx Primary thyroid lymphoma

A

chemo/XRT

240
Q

Tx follicular thyroid ca

A
  • if < 4cm, <45 yo, no distal dz, no fam hx → lobectomy
  • otherwise completion thyroidectomy
  • neck dissection: clinically positive nodes (rare), extrathyroid spread
  • RAI: >2cm, extrathyroid/vascular invasion, node +, anti-TG Ab, elevated TG
241
Q

Thryoid nodes

A

Delphian nodes: w/in anterior suspensory ligament; connect L and R glands
Rotter’s nodes: between pec major and pec minor
Level VI: central compartment LNs

242
Q

Tx Pap thyroid ca in perggo

A

postpone until 2T; if stable, post until after delivery; RAI is c/i

243
Q

Tx Anaplastic thyroid ca

A

aggressive,undiff; mort ~ 100%; no tx; tx- XRT improves short-term survival +/- surg

244
Q

Tx med thyroid ca

A

TOTAL thyroidectomy AND bilateral L VI dissect → complete lateral if +

245
Q

Tx of Thyroiditis:
Hashimoto’s thyroiditis
De Quervain’s/Subacute thyroiditis
Reidel’s thyroiditis

A

Hashimoto’s thyroiditis: AI/lymphocytic; tx- LT4, surg if compression sxs
De Quervain’s/Subacute thyroiditis: tx- NSAID +/- steroids
Reidel’s thyroiditis: tx- steroids, surg if compression

246
Q

Sonograph FNA recs

A

cystic- no bx
isoech/hyperech- FNA if > 2cm
hypoech (high sus)- FNA if > 1cm

247
Q

Tx MEN2A

A

tx pheo 1st w/ adrenalectomy! → then resect T/PT

248
Q

Tx Parathyroid ca

A

en block resection + XRT (not chemo)

249
Q

Pheo w/up:

A

plasma or urine metanephrine (se) → 24-urine metanephrine (sp) → CT +/- MIBG (multi-focal)

250
Q

Tx MEN1

A

tx hyperPTH 1st w/ 4-gland resection (hyperplasia not adenoma) → asses other lesions

251
Q

MEN1/MEN2 genes

A

MEN1: MENIN gene, TSGene
MEN2: RET gene, receptor TK protein, proto-oncogene

252
Q

Hyperaldo w/up:

A

CT → unilateral → lap adrenal; CT → negative or bilateral → bilat venous sample

253
Q

Indic for retroperitoneal adrenalectomy:

A

multiple previous ab surgeries, bilateral lesions

254
Q

Cryptorchidism tx

A

wait until 6m old

if no resolution- elective orchiopexy to decrease r/o torsion, infertility, ca

255
Q

Tx choeldochoal cyst

A 
1- fusiform, excise/REY
2- divertic, excise
3- ampulla, transduo
4- extra/intra, REY
5- intra, trx
256
Q

Tx Biliary atresia

A

REY portoenterostomy (Kasai) → liver trx

257
Q

Neuroblastoma

A

S1-2 (low risk) → surg alone

S3+ → surg + chemo/XRT

258
Q

Hirschsprung surgeries

  • Duhamel
  • Soave
  • Swenson
A

Duhamel: agang stump in place/gang colon pulled behind; neo-rectum; less dissection/stricture
Soave: pull-through; “reverse alte”; remove M/SM; pull bowel within an aganglionic cuff; least dissection
Swenson: original; aganglionic segment resected to sigmoid colon; oblique anastomosis- colon x rectum.

259
Q

Tx Thyroglossal duct cyst

A

excise cyst, duct + mid hyoid

260
Q

Tx ASD

A

surg if sxs or asx < 5 yo; surg before school

261
Q

Tx PDA

A

to close- indomethacin; to open- PGE1

262
Q

Tx Trx of great vessels:

A

1st give PGE1 → ballon atrial septostomy

263
Q

Tx SqCC Lip

A

WLE w/ 3cm margin

radical neck dissection if palp nodes

264
Q

Tx SDH

A

nonop- HDS, <10 mm, <5 mm shift

evac- > 10mm, >5mm shift, delta GCS > 2, cx signs of ICP

265
Q

Tx afib

A

stable- BB/CCB, amio if HF
unstable- SYNCHRONIZED cardioversion
consider acoag after 48h

266
Q

Tx Aspergillosis

A

MC fungal infxn in IC
aspergilloma- resect
inv aspergillosis- voriconazole

267
Q

Px and Tx Histoplasmosis

A

px- ohio river valley

tx- itraconazole → ampho B

268
Q

MOA of antifungals:
Micafungin
Azoles
Amphotericin

A

Micafungin: echinocandin; inhibit glucan x linking
Azoles: ergosterol synth inhibitor
Amphotericin: binds ergosterol and inhibits

269
Q

Tx Soft tissue sarcoma

A

resect w/ 1-2 cm marg
neoadj- rhabdomyosarcoma, Ewing sarc, high grade > 10 cm
adj XRT- > 5cm, high grade, recurrence, close marg
adj chemo- never

270
Q

Tx of seminoma

A

surveillance or chemo/XRT

271
Q

NNT

A

1/ARR

ARR = control rate - event rate

272
Q

RRR

A

(control rate - event rate)/(control rate)

273
Q

Cohort:

A

prosepective; exposed vs. non-exposed

RR- [a/a+b]/[c/c+d]

274
Q

Case control

A

retrospective; diseased vs. non-diseased

OR- (a/b)/(c/d)

275
Q

Type 1 error

Type 2 error

A

Type 1: false positive (a)

Type 2: false negative (b)

276
Q

Periop Warfarin

A

stop 5 days before

indics to bridge: mech valve, h/o TE event, afib only if CHAD/VASC 5-6

277
Q

Periop NOAC

A

stop 2 days before elective surgery

278
Q

Tx keloid

A

Z plasty + steroids + silicone sheets

zAbsite Final 2019 (5 decks)

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