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Truelearn Flashcards

1
Q

primary hyper pth most commonly from….

what if localization studies are negative

A

primary adenoma single in 85%

prepare for bilateral neck exploration

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2
Q

Inclusion and exclusion criteria for superficial surgical wound infections

A
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3
Q

Malignant hyperthermia:
rec mutation?
inh pattern?
usual inciting medicaiton?
Other SEs of this medication? tx? MOA of med?

A

ryanodine receptor
AD
sux
hyperkalemia; dantrolene; depolarizing muscle blockade

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4
Q

Pt populations to hold succinylcholine in ?

A

closed head trauma, burns, NM disease

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5
Q

Standard approach for popliteal aneurysms?

Standard operation?

A

medial

exclusion with ligation and bypass with GSV

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6
Q

describe RAAS components

A
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7
Q

4 classes of pilonidal disease

A
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8
Q

what PFTs must be met prior to pneumonectomy?

Lung resection?

A

fev1>80, DLCO>60, FEV1 >2L

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8
Q

Hypermagnesemia severe range?

EKG changes?

Tx?

A

> 12

Pr interval prolongation

Ca; hydration and diuresis

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9
Q

best test for elderly hip pain after fall

A

CT

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10
Q

2 things that change goiong from class 3 to 4 shock?

A

lethargy/obtunded and absent uop

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11
Q

atypical ductal hyperplasia has a —-% chance of harboring in situ or CA

A

15-30

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12
Q

MC presentation and mammogram finding for DCIS

A

clustered microcalcs

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13
Q

in what order do cell types show up in wound healing? approximate times?

A

Platelets - immed
Neutrophils - 24-48 —-cytokines, debris
Macroghages - 48-96
Lymphocytes
Fibroblasts

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14
Q

3 stages of wound healing and predominant cell types

A

inflam -1-7d - neutrophils, mps, lymph
prolif - 3d-3wk –all
recon - 3wk - fibroblasts

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15
Q

2 collagens in wound healing, when they show up and which is left?

A

3 and 1; 3 spikes in prolif and then 1 takes off and stays; fibronectin is also around

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16
Q

what margins are required for a cancerous polyp snaring to be definitive

A

2mm margins with no base involvement

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17
Q

wound classes and their % chance of SSI

A
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18
Q

when and what multiple of amylase abnormality needs to be present to define panc leak

A

POD3 x 3

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19
Q

differences between the vasculature of the adrenals

A

inf phreni, aorta and renal feed arterial supply b/l

right adrenal vein goes to IVC
left adrenal vein goes to left renal

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20
Q

4 s/s of hypocalcemia?

A

perioral numbness
chevstock - cheek tap
Troussea -BP cuff and carpopedal spasm
prolong qt

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21
Q

pancreatic injury grading

A
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22
Q

confirmatory study for ischemic colitis

A

scope

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23
Q

why altmeir of delorme in necrotic prolapse?

A

delorme just strips mucosa, may not see all full thickness

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24
Q

sensitivity?

A
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25
Q

ppv, npv?

A
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26
Q

specificity

A
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27
Q

amphotericin B MOA?
AE?

A

binds to fungal cell wall sterols
nephro

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28
Q

fluconazole MOA
AE

A

cell wall synth inhibit

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29
Q

capsofungin moa

A

D B glucan synthase inhibition

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30
Q

felon vs paronychia appearance?

MC bug?

definiive tx for felon and why is this so seriosous

A

felon is in volar pulp v infection under nail bed

staph

I&d —- 75% necrosis possible

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31
Q

max ligasure vessel size

A

7MM

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32
Q

visceral Blood vessel diameters

A

splenic - 5mm
cha - 6mm
rha - 3mm
celiac - 8mm
sma - 8mm
ima - 5mm

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33
Q

MCC of cushing syndrome? endo v exo v overall
What is cushing disease

A

cush dis v steroids v steroids

pit tumor – ACTH secreting

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34
Q

3 burn meds and their SEs

A
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35
Q

All sepsis pressors and their MOAs + receptors

A
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36
Q

what other deficiency can hypomagnesemia cause?

A

Calcium

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37
Q

GB cancer staging and next steps

A
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38
Q

what defines unresectable GB cancer

A

PV or hepatic artery
2 or more organs

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39
Q

Differing features among crohns and uc

A

crypt abscesses in uc, only colon and rectum, only mucosa and submucosa

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40
Q

burn grades and appearances

A
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41
Q
A
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42
Q

how does desmopressin work?

what if that does not work for uremic bleeding

A

increases factor 8 and vwf

dialysis

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43
Q

transfusion reaction types and their treatments

A
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44
Q

BIRADS?

A
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45
Q

what birads do we start biopsies

A

4

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46
Q

cushing diagnosis flow chart

A
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47
Q

Tx for branchial cleft cyst if infection concerns

A

always delay surgery, tx with abx in the meantime

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48
Q

tx of biliary injury iatrogenic and trauma

A

A single duct < 3 mm in size identified on cholangiography, draining a single segment/subsegment of liver can be primarily ligated; 4 mm or greater generally requires repair.

< 50% circumference injury, non-electrocautery: primary repair with 4-0 or 5-0 absorbable suture, placement of T-tube

> 50% circumference injury OR electrocautery: biliary-enteric reconstruction, typically Roux-en-Y choledochojejunostomy vs choledochoduodenostomy

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49
Q

What is involved in a superficial inguinal nod dissection?

when should a deep dissection be performed for melanoma?(3)

what is cloquets node

A

femoral canal nodes

cloquets is pos, large numbe of superficial nodes pos, or imaging concerns

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50
Q

what is the next step after deep inguinal node dissection

A
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51
Q

4 cancers associated with EBV

A

burkit lymphoma, gastric ca, nasopharyngeal, hodgkins

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52
Q

what cancers are assoc with li fraumeni

gene?

A

tp53

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53
Q

How to cover former trach site after repositioning pos innominate ligation

A

local strap muscle flap

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54
Q

preferred reversals for anticoags in head trauma

A
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55
Q

inflammatory breast cancer criteria

A
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56
Q

MC complication of hepatic trauma

A

bile leak

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57
Q

tx for symptomatic hemangioma in child

A
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58
Q

MC suppurative thrombophlebitis bug

A

staph aureus

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59
Q

normal systemic periph vasc resist. numbers?

what are elevated peak pressures?

A

700-1500

40

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60
Q

What must be repleted first in an altered gastric bypass patient with dehydration 6 weeeks later

A

thiamine as it is absorbed in the duo and jejunum

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61
Q

what incision do you choose for sma arteriotomy and why

A

transverse with healthy vessel

longitudinal if unhealthy and patch may be needed

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62
Q

How are sb hemangiomas dg and how should they be managed

A

CT IV

no intervention if asymptomatic
endo or IR can control bleeding
surgery if all else fails

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63
Q

2 most common sites for peripheral artery aneurysmsative sizes?

A

Pop then CF

2 and 2.5

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64
Q

CDH1 prophylaxis timing?

A

total gastrectomy 18-30 and screen like BRCA

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65
Q

what is the mc electrolyte abnormality in SBO

mechs?

so what type of fluid are you giving

A

hypok hypo cl met alk

vomiting Cl and H leads to higher bicarb in blood

RAAS tries to retain H and drops K

LR balanced

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65
Q

MCC of intussusception in adults

A

Ca

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66
Q

4 common bugs in SB overgrowth

4 structures that predispose

A

streptococci, bacteroids, Escherichia coli, and lactobacillus.

blind loops, fistula, larg divert, stricture

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67
Q

what can be seen on cbc for SB overgrowth patients and why?

A

B12 deficiency due to bacteria overconsumption

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68
Q

testing for sb overgrowth

imaging?
labs?

A

A d-xylose test (carbohydrate breath test) is useful. The metabolism of carbohydrate substrates from bacteria leads to the production of hydrogen and/or methane, which is detected in the breath.
Cross-sectional imaging may serve to delineate anatomy if blind loops or strictures are present.
Laboratory findings include low vitamin B12, thiamine, and niacin levels, with high serum folate and vitamin K levels.

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69
Q

non op tx for sb overgrowth

MOA and duration

A

rifaximin

DNA dep RNA poly; 14 d

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70
Q

supplements for blind loop patients

A

B12 and med chain FA

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71
Q

2 most important surgical anatomy factors in optimizing short gut

how do these help

A

keeping IC valve and ileum

ICV allows for transit control

Ileum absorbs ADEK, B12 and bile acids; most adaptable

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72
Q

compare ileum and jejunum

A
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73
Q

4 instances of TPN failure in short gut

A

Parenteral nutrition–associated liver disease
Loss of central venous access (ie, loss of three to six central venous access sites in children or two to four central venous access sites in adults)
Recurrent catheter-related sepsis or a single episode of fungal sepsis
Recurrent bouts of severe dehydration or metabolic abnormalities

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74
Q

absolute contraindication to SB transplant

A

Active infection or malignancy

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75
Q

3 long term complications with short gut outside of intestine

A

Calcium oxalate kidney stones and gallstones
Hepatic and biliary disease
Metabolic bone disease

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76
Q

alternate PE findings for appendicitis

A

Rather, patients with a retrocecal appendix will often have a positive psoas sign (pain with active flexion of the right hip), whereas patients with a pelvic appendix will often have a positive obturator sign (pain with passive adduction of a flexed right hip).

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77
Q

For appy, what causes luminal obstruction in kids v adults

A

MALT v fecelith

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78
Q

median age of appendicitis

A

28

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79
Q

assoc disease with appy

A

CF

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80
Q

Appy ddg in women

A

pelvic inflammatory disease, adnexal cysts, ovarian torsion, ectopic pregnancy, or a tubo-ovarian abscess should be considered.

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81
Q

percent of pop with appy

A

6%

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82
Q

All the appy PE signs

A
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83
Q

negative appy risk for pregnancy

A

Negative appendectomy is associated with a 4% rate of fetal loss and a 10% rate of early delivery.

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84
Q

considerations in interval appy

A

An underlying mass should be excluded with colonoscopy in appropriate patients.
Delayed appendectomies are recommended for two reasons: to prevent the recurrence of appendicitis and to exclude neoplasms within the appendix or cecum.
The incidence of appendiceal neoplasms at appendectomy is approximately 1% to 1.5% and increases after age 40. This risk should be weighed when considering interval appendectomy.

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85
Q

Lap appy risk %s

A

Patients undergoing laparoscopic appendectomies have a 1.2% chance of requiring conversion to open operation, a 0.7% risk for intraoperative complications, and a 1.5% risk for postoperative complications.

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86
Q

Describe toxigenesis of C diff

A

Toxigenic strains produce two toxins, A and B, which cause mucosal injury and increased fluid secretion from colonic enterocytes, in turn causing the characteristic watery diarrhea seen in active infection. Toxin B is more than 10 times as potent as toxin A.
Localized necrosis of the mucosa and the subsequent inflammatory cascade lead to the formation of pseudomembranes on the mucosal surface, which are localized collections of cellular inflammatory debris.

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87
Q

What hx should be asked if concern for c diff

A

Workup for C difficile colitis is indicated for patients with clinically significant watery diarrhea (>3 episodes in 24 hours), recent antibiotic use (most commonly within 2 weeks prior to the onset of symptoms), recent hospitalization or residence in a health care facility, or a known history of C difficile infection.

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88
Q

first line test for c diff; whats the issue

next?

A

stool toxin, false negatives

NAAT — looks for gene encoding toxin B

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89
Q

concerning colonic measurements in c diff

A

colon> 6cm
cecum>12

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90
Q

2 labs for severe c diff

A

15k wbc or 1.5 cr

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91
Q

what may be a harbringer of worsening c diff colitis?

this is secondary to….

A

worsening ileus; colonic atony

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92
Q

mortality and stoma reversal rates with c diff colectomy

preferred operation?

A

Mortality rates for C difficile colitis requiring surgery are greater than 50%.
Stoma reversal rates are less than 35%.

total

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93
Q

recurrent c diff recs: 1st 2nd 3rd

A

For the first recurrence: pulse-tapered oral vancomycin or oral fidaxomicin is indicated if the infection was initially treated with vancomycin. If it was initially treated with fidaxomicin or metronidazole, oral vancomycin is indicated.
For the second recurrence: longer courses of vancomycin, fidaxomicin, rifaximin, and/or combinations thereof are indicated.
Consider fecal microbiota transplant in patients with multiple recurrent C difficile infections despite multiple rounds of adequate therapy.

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94
Q

inpatient acute c diff colitis mild, severe and fulminant medical txs

what if ileus is present?

A

mild: oral vanc or fidaxomycin

sev: same

fulm: oral vanc and IV metro

rectal vanc enemas for ileus

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95
Q

tracking for C diff incidence

A

The Centers for Medicare & Medicaid Services requires that all acute care hospitals, long-term care facilities, and inpatient rehabilitation facilities report C difficile infections via the National Healthcare Safety Network run by the Centers for Disease Control and Prevention.
Laboratory-positive infections must be reported, as well as the patient’s location at the time of positive specimen collection. Data are collected from inpatient units, emergency departments, and 24-hour observation units (ie, clinical decision units).

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96
Q

What therapy is given after all mastectomies and lumpectomies?

What are the benefits?

A

WB rads

dec local rec
inc survival

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97
Q

4 patients that cant get breast cons therapy for DCIS

A

1st tri preg
diff pos margins
small breasts
diffuse susp calcs

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98
Q

MC complication of PEG tube

A

infection

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99
Q

Tx for any solid intratesticular mass?

A

radical orchiectomy

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100
Q

What are the 3 antigen presenting cells and which one predominates

A

Dendritic

mp, B cell

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101
Q

kupffer cells

A

liver Mps

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102
Q

NK cells attack cells that lack what

A

MHC1

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103
Q

IL for B cells

A

4

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104
Q

Reboa zones and where not to occlude

A
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105
Q

Single bx for barretts confirms high grade, what now

tx

A

4 quad bx every 1 cm

EMR

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106
Q

MCCx of hemorrhoidectomy and why

A

urinary incontince

-ivf
-pain irritating nerves
-adv age

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107
Q

Signs concerning for primary graft non function for liver tx

tx

A

re trans

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108
Q

First line tx for acute rejection of transplant

2nd?

A

steroids

anti-thymocyte globulin

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109
Q

Mondor dis primary cause

secondary?

A

idiopathic

trauma, iatrogenic, infection, ca, hypercoag, vasculitis

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110
Q

MCC of suppurative jugular vein thrombo

A

pharyngitis

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111
Q

Dg imaging for colovesical fistula

A

CT

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112
Q

MC side of dissection in type B

A

posterolateral

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113
Q

Gastric NET endoscopic resection cutoff?

A

2cm as 10% nodal mets at that point

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114
Q

tracheal injury mng:
1. small anterior defects
2. transection(howmany rings can be lost?)
3trach?

A
  1. simple transverse
  2. 6
  3. Devastating injury
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115
Q

positive predictors for successful reflux surgery

A

typical gerd signs
demeester appropriate
good response to ppi

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116
Q

ca in celiac patients

A

enteropathy assoc t cell lymphoma

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117
Q

MCC of liver failure in US?

tx?

A

acetam

n-acetyl

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118
Q

do i have to tell patients im HIV pos?

A

not legally, but ethically

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119
Q

MC long term sequelae of ileal pouch

A

pouchitis

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120
Q

preferred graft type in sma bypass

A

PTFE

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121
Q

measurement cutoffs for arteries and veins for fistula formation wrist?

upper arm?

A

2mm artery and 2-3mm veins

3?

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122
Q

rule of 6s for av fistula formation

A
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123
Q

When can a pregnant woman get rads for breast ca?

what would she receive otherwise if operative

A

2nd and 3rd

simple mastectomy and SLNB

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124
Q

What is the proven benefit of a trach

A

less sedation to aid in weaning

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125
Q

3 mechs of PTH ca inc

A
  1. osteoclast stim
  2. stim calcitriol(VD) formation
  3. DCT rabsorb in kidney
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126
Q

3 MC bugs in SBT

A

e coli, kleb, pneumococc

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127
Q

Most important vitamin in wound healing

3 mechs

A

collagen cross linking
makes hydroxyproline
stabilizes collagen

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128
Q

what is a positive apnea test?

A

pCO2 rises to 60 off vent

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129
Q

combined invasice breast ca and DCIS tumor margin rules

A

negative ink is good

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130
Q

why 2mm for DCIS

A

skip lesion

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131
Q

location for thoracentesis

A

8th midax and mid scap

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132
Q

In patients with hematochezia and hypotn what must be ruled out

A

UGIB

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133
Q

absolute indications for dialysis

relative?

A

uremic pericarditis, pleuritis, encephalopathy

AEIOU

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134
Q

mid shaft humoral fracture is associated with what nerve injury

A

radial

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135
Q

radial , median and ulnar distal ue motor actions?

A

radial - thumb and wrist ext
median thumb and wrist flex
ulnar - all pinky stuff

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136
Q

early vs late graft infection bugs

A

aureus vs epidermidis

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137
Q

2 parts of treatment for TTP?

A

steroids and plasmapheresis

give new ADAMTS3 while suppressing further destruction by immune system

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138
Q

2 GIST grade determinants

A
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139
Q

when should warfarin be bridged for surgery concerning AF stroke risk

what trial supports this

A

CHADSVASC of 3

BRIDGE trial

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140
Q

MCC hepatits in west vs east

A

Western is B
Eastern is C

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141
Q

Do any superficial vein thrombi need anticoag?

A

3 cm from saphenousfemoral junction

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142
Q

epithelial ovarian tumor marker

A

CA 125

143
Q

MCC of liver failure in
US v world

A

acetam vs viral

144
Q

prosthetic vs mechanical benefit

downside

MCC of death for both

A

no long term anticoag

dont last as long

CHF

145
Q

4 genetic syndromes involving PNETs

A

VHL, MEN1, NF1, tuberous sclerosis

146
Q

dominant cell type in proliverative phase

A

fibroblasts

147
Q

what is the max tensile strength after wound healing

A

80% at 6 weeks

148
Q

what effect do myofibroblasts have on wound

A

contraction

149
Q

MCCx of ERCP

A

pancreatitis

150
Q

MC site of renal mets

A

lung

151
Q

3 high risk CV surgeries; overall % risk

A

aortic, major vasc, periph vasc

> 5

152
Q

Which toxin for C diff causes intestinal necrosis

A

A

153
Q

lymphangitis abx?

A

clindamycon

154
Q

3 expected lab findings post splenectomy

A

mild leuko
thrombocytosis
howell jolly and targets

155
Q

critical limb ischemia ABI

A

0.5

156
Q

When to perform endoscopic ultrasound for panc cyst?

A
157
Q

large symptomatic splenic cyst treatment? size cutoff

A

surgery

5cm

158
Q

what would keep one from doing combined liver and colon resections?

A

symptomatic, multi segmental, or complex rectal surgery

159
Q

3 risk factors for spontaneous retroperitioneal hemorrhage

A

old, antiplatelet and renal impairment

160
Q

What is the borderline gallbladder polyp size and when should this class be removed?

What size always comes out

A

Symptomatic or high risk:older than 50, primary sclerosing cholangitis, Indian ethnicity, and the presence of a sessile polyp (including focal wall thickening >4 mm).

10mm

161
Q

complete surgical management of gallstone ileus?

A

ONLY enterostomy

162
Q

what is the benefit of lap vs open inguinal for cirrhotic patients

A

less bleeding

163
Q

Go to surgery for femoral hernia repair if able to reduce

A

lap

164
Q

What should you do for a preg lady with symp stones recurring in the 3rd trimester

A

operate

165
Q

IVF strategy for pyloric stenosis baby

A

f the initial chloride is less than 97 mmol/L but greater than 85 mmol/L, 2 boluses of 20 mL/kg of normal saline are administered. If the chloride is less than 85 mmol/L, 3 subsequent boluses of 20 mL/kg are given. Each of the boluses is separated by 1 hour to allow for tissue rehydration without causing unnecessary diuresis from rapid intravascular expansion. Serum electrolytes are then repeated after the requisite number of boluses are given. During ongoing bolus fluid resuscitation, maintenance fluid is administered. In addition to boluses of normal saline, depending on the degree of hypochloremia, the appropriate maintenance fluid to administer to this patient is 5% dextrose in 0.45% normal saline.

needs K too

166
Q

Size cutoffs for pyloric stenosis

A

3mm and 15mm

167
Q

2 required investigations prior to fundo for GERD

what is accessory if above positive for gerd

A

EGD and manometry

ph test

168
Q

Thiamine deficiency s/s?

B12?

A

Thiamine deficiency, or beriberi, can present in 2 forms. “Wet” beriberi can present with tachycardia, right heart failure and respiratory symptoms, hypertension, and vasodilatory edema. “Dry” beriberi, which is more common, presents with predominant neurologic manifestations. These include lower extremity neuropathy, myalgia, atrophy, and paraplegia in severe forms.

peripheral neuropathy and megoblastic anemia

169
Q

If a roux comes in with tachycardia…..

A

explore!

170
Q

Tx for ilecolic anastomosis stricture in crohns

A

dilation

171
Q

next step for esoph adeno if mass cant be traversed with scop

A

PET/CT

172
Q

screening guidelines for barretts

A

Gastroenterology guidelines recommend screening for Barrett esophagus in men with chronic (>5 years) or frequent heartburn/acid regurgitation who have 2 or more additional risk factors (age >50, current smoker or history of smoking, central obesity, family history of Barrett esophagus, or esophageal adenocarcinoma in a first-degree relative).

173
Q

surveillance sched:
barretts
lgd
hgd

A

3-5y
1y or ablation
EMR

174
Q

HGD barretts ca risk annually

A

7%

175
Q

only thing that improves lap insufflation pain

A

lower pressure

176
Q

duodenal polyp findings and improtance for risk

A
177
Q

Extremely dense breast tissue is a ___ relative risk for breast cancer in this age group

A

2
40-49

178
Q

what lifetime risk indicates annual MRI for breast cancer?

A

20%

179
Q

preferred imaging modality for neoadjuvant follow up for breast cancer

A

mri

180
Q

higher incidence of what comparing autologous to implants for breast rocon

A

periop complications

181
Q

calcification descriptions and their risk %:
rim -
linear
round -
dystrophic

A

rim - <2
linear -2-95 (78)
round - <2
dystrophic -<2

182
Q

4 high risk calcification appearances

A

linear, pleiomorphic, coars heterog, amorphous

183
Q

benign sounding calcifications

A

Round-shaped calcifications and rim calcifications are classified as typically benign with less than 2% risk of malignancy. The fifth edition combined eggshell and lucent-centered calcifications into rim calcifications. Additionally probably benign calcification descriptors include large rod-like, coarse, “popcorn like,” vascular, dystrophic, and milk of calcium.

184
Q

granulomatous mastitis tx

A

steroids or MTX if needed

185
Q

indications for genetic testing for breast cancer

A
186
Q

stromal fibrosis on core needle in breast, next step if concordant with rads

A

follow up imaging

187
Q

`follow up after stage 2 breast full treatment

A

annual mammogram

188
Q

screening sched for brca

A

annual MRI at 25 and mammos plus mri at 30
rec BSO
+/- bpm

189
Q

what receptor status is eligible for gene expression assay in breast

what is this hlepful for

A

ER+

adj chemo decisions

190
Q

How to fundo a sleeve

A

Hill esophagogastropexy – lesser curve to MAL

191
Q

highest risk post transplant ca

A

SCC of skin

192
Q

When to do Delorme

A

small less than 5cm without strangulation

193
Q

on what aspects of the arm are fasciotomies performed, what structure is included

A

volar and dorsal with carpal tunnel release

194
Q

4 TASC c lesions

A
195
Q

most common site of CRC recurrenc ranked

A

liver, lung, local

196
Q

Go to HIPEC drug

MOA

A

mytomycin

crosslinks–damages DNA syynth

197
Q

what is the new tissue involvement for stage 3 sacral ulcer

A

subcut fat

198
Q

first step in colonic pseudo obstruction workup after CT

Tx

A

barium enema

neo

199
Q

most sensitive imagin modality to detect small liver mets

A

IO u/s

200
Q

Explain TBI categories

A
201
Q

associate vit deficiency 2/2 carcinoid syndrome consumption of tryptophan

s/s?

A

B3 - niacin

derm, dem, diarrhea

202
Q

what is recycled in the Cori cycle

what metabolic state is the patient in

A

lactate and pyruvate to glucose

starvation

203
Q

Newest rec for peds bleeding diverticula?

exceptions?

A

neoplasm, ischemia, or wide base

204
Q

heller myotomy rule

A

5 up 2 down

205
Q

what causes skin changes in inflam breast ca

A

tumor cells in lymphatics

206
Q

When does the radical cholec upgrade given T stage and what to

A

T3 through serosa

needs full segmental 4b 5

207
Q

inc ICP triad

2 accessory symptoms

A

cushings: bradycardia, resp depress, htn

6th crania nerve palsy – lateral rectus weakening blurry vision
pain

208
Q

bladder pressure for ACS

A

20

209
Q

peripheral nodular enhancement in liver imaging means

A

hemangioma

210
Q

Differnetiate the CT findings for benign liver tumors

A
211
Q

next step for panc fistula if output persists

A

stent and sphincterotomy

212
Q

risk of strangulation for femoral hernia

A

45%

213
Q

MC STV in US

A

condyloma accuminata

214
Q

what is the known benefit of closing fascia for laparoscopic hernia repair

A

seroma dec

215
Q

severe short bowel medication and effects

A

GLP2 – mucosal growth

216
Q

imaging for breast mass in man

A

u/s and mammo

217
Q

MCC of goiter and hypothyroidism>, also called

abs?

A

Hashimoto -chronic lymphocytic thyroiditis

thyroid peroxidase ab, throglobulin abs

218
Q

MC site for GI NET? followed by….

A

rectum then SB(ileum)

219
Q

MC panc adeno oncogene

A

KRAS

220
Q

what thyroid cancer spreads hematogenously

A

follicular

221
Q

Nigro protocol total duration? What happens at the end?

A

12 weeks then re eval
if persistent then re eval in 4 then 3m
if progress APR
if remission then q3 m DRE

will then make operative decision

222
Q

What causes amaurosis fugax in carotid stenosis

A

opthalmic artery blockage on same side

223
Q

When can spleen be preserved with pancreatic cancer?

A

low risk tumors, NOT adeno

224
Q

MEN 2 A components

oncogene

A

primary hyperthyroid
pheo
medullary

RET

225
Q

N2 colorectal

A

4 or greater nodes

226
Q

MArgins for Phyllodes

A

1cm

227
Q

medial pectoral nerve innervates…

lateral?

A

both

pec major

228
Q

MC undelying mass for bloody nipple discharge

A

intraductal papillomas – excise them

229
Q

MCC of OPSI

A

strep pneum

230
Q

5 melanoma bx markers

A

HMB
Malan A
SOX10
MITF
S100

231
Q

drainage amount throshold for biloma ERCP and stent

A

300cc/d

232
Q

ALH lifetime risk inc

A

4 fold

233
Q

pre op ekg algorithm

A
234
Q

3 meds that can cause gynecomastis

A

dig, theoph, and tiazide

235
Q

MCC of massive hemothorax

mortality per repair type?

A

lung laceration

236
Q

dg of gastric band erosion stable v unstable

A

endo

ugi

237
Q

ovarian vein thrombosis tx

A

anticoag, abx

238
Q

preferred pregnant or malignancy induced dvt tx

NOAC cxs? relative?

A

lovenox

child c, breast feeding

renal, sev obese, child a or b

239
Q

what was the suture size in STITCH

A

2-0

240
Q

olaparib is rec for what cancer

A

TNBC wutg BRCA

241
Q

MC minor salivary tumor/

malign rate?

where?

A

adenoid cystic
high
hard palate

242
Q

duration of provoked dvt tx

A

3m

243
Q

what dens fracture needs operation

A

Type 2

244
Q

histology descriptions of radial scar, inflam bc, pagets eczema, and phyllodes

A
245
Q

5 half lives of a drug is now at what % of the final steady state

A

97%

246
Q

inheritance pattterns of Menin and RET

A

AD

247
Q

ADEK deficiency effects

A
248
Q

SE deficiency

A

cardiomyopathy

249
Q

Zn deficiency

A

growth fail, skin lesions

250
Q

hypo phos

A

bone pain

251
Q

Cu deficiency(5)

A

anemia, neutropenia, pigmentation, arrythmias, bone

252
Q

Chromium deficiency

A

diabetes like

253
Q

mc adrenal met

A

lung

254
Q

MC presentation of primary hyperaldosteronism

A

bilateral hyperplasia

255
Q

blair incision

A
256
Q

posterior hip dislocation associated injury

A

sciatic

257
Q

Appy carcinoid rules

A
258
Q

MCC of upper lip v lower

A

basal

squamous

259
Q

what big part of an sma embolism ex lap go first

A

revasc

260
Q

first step in looking for accessory spleen

A

sulfur colloid

261
Q

histologic description of fibromuscular dysplasia

A

thickening of media with collagen formation

262
Q

tamoxifen actions

A

estrogen antagonist but agonist in all other tissues

leads to DVt and endometriosis

263
Q

meperidine SE

A

seizures

264
Q

internal mammary artery is a branch of the _____

A

subclavian

265
Q

hydrofluric acid burns are treated with ______

A

calcium

266
Q

watery diarrheal metabolic acidosis make up

A

hypochloremic and hypokalemic

267
Q

when to pre-emptively band varices

A

> 5mm in Child B or C

268
Q

biliary obstruction effects what vitamins

A

ADEK

269
Q

Ketamine dosing

A

0.5-1 mg/kg – analgesic
1-2 — sedation

270
Q

Now the preferred method for retained foreign body check

A

wand

271
Q

Go to STSG donor site dressing

A

WET

272
Q

current state of TXA

A

within one hour for GCS 15-9

or prehospital severe

no increase in DVT

273
Q

What is TRALI similar to? how are they different

TRALI v TACO

A

ARDS, timing

pulmonary vs cardiogenic overload

274
Q

what is the overall message with DECRA vs RESCUEicp

A

3 v 10 days refractory icps

late tx with decompressive craniotomy is better

275
Q

go to dg modality for depth of injury after caustic ingestion

A

CT

276
Q

what are the CT findings for adrenal carcinoma

overall mng?

what is a high risk lesion

A

houndsfields greater than 10 and less than 40% washout

surgery then adjuvant if high risk with mitotane

tumor spillage, ki67>10, mitotic >20 per 50

277
Q

adjuvant therapy for adrenal Ca

A

mitotane

278
Q

tx of fistula with minor sphincter involvement

A

fistulotomy primary

279
Q

causes of end tidal CO2 drop intraop

A

PE
MI
technical
bronchospasm

280
Q

risk for TRAM flap-

A

obesity

281
Q

best pos prognosticator with CRC w/ liver mets

A

response to neo

282
Q

VTE regimen for colorectal ca post op patients

A

4week

283
Q

what is a striking feature of this abscess

A

amaebic abscess if hx fits

simple septation

284
Q

milrinone moa

A

PDE 3 — inc cardiac contractility

285
Q

Endo AAA repair sizing rules:
prox neck length and diam
iliac landinzone and diam
take off angle

A

15mm; 17-32mm
20mm; 7-20
60 degrees

286
Q

Treatment of LAMN with mucin pooling after appy

A

go straight to debulkign and hipec, no right hemi

287
Q

fecal dna test needs to be done how often

A

3y

288
Q

Haggit classification is irrelevent if ……

what is the Haggit classification at which formal resection is indicated

A

poor diff, high grade, LV invasion, PN invasion

4– bowel wall submucosa

289
Q

Sessile polyp classes and which one can be watched

A

SM1 with less than 50% horizontal spread —- no high risk features

290
Q

always do this after resection of small gastric polpys

A

get bx of normal tissue in several spots

291
Q

Shallow anorectal fistula management

A

primary fistulecotmy

292
Q

what is mechanical bowel prep good for

air leak test?

A

SSI

anastomotic leak

293
Q

worst prognostic factor for gastric adeno

A

proximal location, increased depth and nodes

294
Q

MLH1 and PMS2 + BRAF =

A

sporadic CRC

295
Q

bad size and bad depth for rectal NET

what is this T stage usually

A

2cm; MP

T2

296
Q

treatment for post hiatal hernia repair GOO due to vagal nerve injury

A

per oral pyloromyotomy

297
Q

colonic lymphoma managment

A

surgery the CHOP

298
Q

GIST vs leiomyom vs NET histo

when would we need to differentiate these

A

c Kit

Spindle with desmin

spindle without desmin

SM mass in rectum or esophagus

299
Q

Layers of the esophagus and treatments per the level of esoph adeno involved

A

muc -EMR or esoph

sm - esoph

musc - neo and esoph

300
Q

internal anal sphincter vs ext location

A
301
Q

GS for esoph nodal staging

A

us

302
Q

MC type of intussuseption

A

ileocolic then ileoileocolic

303
Q

where does the lateral PJ for a peustow end?

A

start of head to tail

304
Q

when can a fem pseudo be obs

A

less than 2cm

305
Q

what is the new parkland formula

target uop in peds v adults

A

Brooks 2 instead of 4 x % x /mlkg

1/2 first 8h then 1/2 16 h

0.5-1 vs 1-1.5

306
Q

mc met site for phyllodes

A

lung

307
Q

mc sign for endometrial ca

demo?

A

vaginal bleeding

308
Q

marasmus?

diff with kwashiorka?

A

total calorie proetein wasting

no edema or ansarca

309
Q

when are thyroidectomies in the MEN classes now

A

2A - 5y

2B -1y

310
Q

What is the only cdiff operation

A

total w/ end

311
Q

80% of polyp will take this long to turn into CRC

What type are the other percent and what gene is involved

A

10y

sessile serrated, BRAF

312
Q

time limit for thrombosed hemorrhoid excision

A

48h

313
Q

rectal net size and layer cutoff for LAR

A

2cm, SM

314
Q

anal squamous cell ca virus

A

hpv16

315
Q

surveillance colonoscopy guidelines

A
316
Q

4 pos indicators for pos margins in stomach adeno

A

> 5cm, signet cells, adv T stage, prox location

317
Q

if CT not confirmatory for CRC met then what is next

A

MRI

318
Q

rec for uncomplicated divericulitis in transplant patients

rec for low dose steroid CR anastomosis in post transplant

A

obs

ok to do

319
Q

What is the pref op for dysplasia found in a long time UC pt

what would alter this course and how

A

total procto

total abdominal alone if malnutrition or severe illness present

320
Q

benefit of total neoadjuvant for rectal vs neo and adj

A

less toxicity

321
Q

who gets neo for rectal ca

what defines stage 2

A

stage 2 and up

past the MP to mesorectal land

322
Q

does perforation matter if all other characteristics are ok for appendiceal carcinoid

A

na dawg

323
Q

what does basal cell look like

A
324
Q

MC skin cancer

A

basal cell

325
Q

Precursor lesion for second most common skin cancer

A

actinic keratosis

326
Q

neuroendocrine cell skin cancer

how to stage

how to treat

A

Merkel cell

PET

WLE w/ SLNB

327
Q

excisional margins for non melanoma cancers

A

4-10mm margins

328
Q

scc on burn

A

marjolin ulcer

329
Q

merkel cell margins

adjuvant

A

1-2cm

rads

330
Q

merkel cell pic

A
331
Q

subungal melanoma tx

SLNB?

A

amputation
yes if greater than 1mm depth

332
Q

lymphangitis bug

A

strep pyogenes

333
Q

fournier

A

ecoli, entero, kleb

334
Q

concerning signs of soft tissue mass malignancy

A

fixed mass, painful mass, increased size (> 3 cm), and depth of mass within the extremity compartment

335
Q

desmoid recurrence rate

A

50%

336
Q

what sarcomas get rads?

adj chemo?

A

5cm, high grade

stage 3 pelvic/rp

337
Q

pediatric blood bolus calculation

A

10-20 ml/kg

338
Q

carboxyhb tx

A

high flow oxygen

339
Q

bacitracin use?

SE?

A

2nd degree

nephro

340
Q

mupirocin?

SE?

A

staph infection

irritaiton

341
Q

silver sulffadizaine

SE

A

third deg bruns with gram neg coverage

neutropenia and thrombocytopenia

342
Q

mafenide

A

3rd deg; pseudo, eschar

met acidosis

343
Q

silver nitrate SEs

cx in ..

A

methhemoglobinemia, hyponatremia/cl/k/ca

g6pd def

344
Q

hypothermia classes and treattment

A
345
Q

frostbite initial treatment

A

warm body, warm water, drain clear blisters

346
Q

skin graft type for joints

A

full thickness

347
Q

malignant bowel obstruction alternative from surgery

A

decompressive G tube

348
Q

which is the mens BRCA

A

2

349
Q

what anal fissure medication causes headaches

A

nitrates

350
Q

preferred flap for irradiated APR defect

A

RAM flap

351
Q

hawthorne bias

A

they know they are observed

352
Q

berkson bias

A

chosen population is not generalized(only inpatient for ecample)

353
Q

pygmalion effect

A

researcher opinion bias

354
Q

paired v unpaired test

A

2 groups

before and after one treatment

2 separate txs

355
Q

chi square?

A

2 groups categorical outcomes

356
Q

ANOVA?

A

before and after continuous with more than 2 groups

Written Boards - Final (21 decks)

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