Truelearn Flashcards
primary hyper pth most commonly from….
what if localization studies are negative
primary adenoma single in 85%
prepare for bilateral neck exploration
Inclusion and exclusion criteria for superficial surgical wound infections
Malignant hyperthermia:
rec mutation?
inh pattern?
usual inciting medicaiton?
Other SEs of this medication? tx? MOA of med?
ryanodine receptor
AD
sux
hyperkalemia; dantrolene; depolarizing muscle blockade
Pt populations to hold succinylcholine in ?
closed head trauma, burns, NM disease
Standard approach for popliteal aneurysms?
Standard operation?
medial
exclusion with ligation and bypass with GSV
describe RAAS components
4 classes of pilonidal disease
what PFTs must be met prior to pneumonectomy?
Lung resection?
fev1>80, DLCO>60, FEV1 >2L
Hypermagnesemia severe range?
EKG changes?
Tx?
> 12
Pr interval prolongation
Ca; hydration and diuresis
best test for elderly hip pain after fall
CT
2 things that change goiong from class 3 to 4 shock?
lethargy/obtunded and absent uop
atypical ductal hyperplasia has a —-% chance of harboring in situ or CA
15-30
MC presentation and mammogram finding for DCIS
clustered microcalcs
in what order do cell types show up in wound healing? approximate times?
Platelets - immed
Neutrophils - 24-48 —-cytokines, debris
Macroghages - 48-96
Lymphocytes
Fibroblasts
3 stages of wound healing and predominant cell types
inflam -1-7d - neutrophils, mps, lymph
prolif - 3d-3wk –all
recon - 3wk - fibroblasts
2 collagens in wound healing, when they show up and which is left?
3 and 1; 3 spikes in prolif and then 1 takes off and stays; fibronectin is also around
what margins are required for a cancerous polyp snaring to be definitive
2mm margins with no base involvement
wound classes and their % chance of SSI
when and what multiple of amylase abnormality needs to be present to define panc leak
POD3 x 3
differences between the vasculature of the adrenals
inf phreni, aorta and renal feed arterial supply b/l
right adrenal vein goes to IVC
left adrenal vein goes to left renal
4 s/s of hypocalcemia?
perioral numbness
chevstock - cheek tap
Troussea -BP cuff and carpopedal spasm
prolong qt
pancreatic injury grading
confirmatory study for ischemic colitis
scope
why altmeir of delorme in necrotic prolapse?
delorme just strips mucosa, may not see all full thickness
sensitivity?
ppv, npv?
specificity
amphotericin B MOA?
AE?
binds to fungal cell wall sterols
nephro
fluconazole MOA
AE
cell wall synth inhibit
capsofungin moa
D B glucan synthase inhibition
felon vs paronychia appearance?
MC bug?
definiive tx for felon and why is this so seriosous
felon is in volar pulp v infection under nail bed
staph
I&d —- 75% necrosis possible
max ligasure vessel size
7MM
visceral Blood vessel diameters
splenic - 5mm
cha - 6mm
rha - 3mm
celiac - 8mm
sma - 8mm
ima - 5mm
MCC of cushing syndrome? endo v exo v overall
What is cushing disease
cush dis v steroids v steroids
pit tumor – ACTH secreting
3 burn meds and their SEs
All sepsis pressors and their MOAs + receptors
what other deficiency can hypomagnesemia cause?
Calcium
GB cancer staging and next steps
what defines unresectable GB cancer
PV or hepatic artery
2 or more organs
Differing features among crohns and uc
crypt abscesses in uc, only colon and rectum, only mucosa and submucosa
burn grades and appearances
how does desmopressin work?
what if that does not work for uremic bleeding
increases factor 8 and vwf
dialysis
transfusion reaction types and their treatments
BIRADS?
what birads do we start biopsies
4
cushing diagnosis flow chart
Tx for branchial cleft cyst if infection concerns
always delay surgery, tx with abx in the meantime
tx of biliary injury iatrogenic and trauma
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
What is involved in a superficial inguinal nod dissection?
when should a deep dissection be performed for melanoma?(3)
what is cloquets node
femoral canal nodes
cloquets is pos, large numbe of superficial nodes pos, or imaging concerns
what is the next step after deep inguinal node dissection
4 cancers associated with EBV
burkit lymphoma, gastric ca, nasopharyngeal, hodgkins
what cancers are assoc with li fraumeni
gene?
tp53
How to cover former trach site after repositioning pos innominate ligation
local strap muscle flap
preferred reversals for anticoags in head trauma
inflammatory breast cancer criteria
MC complication of hepatic trauma
bile leak
tx for symptomatic hemangioma in child
MC suppurative thrombophlebitis bug
staph aureus
normal systemic periph vasc resist. numbers?
what are elevated peak pressures?
700-1500
40
What must be repleted first in an altered gastric bypass patient with dehydration 6 weeeks later
thiamine as it is absorbed in the duo and jejunum
what incision do you choose for sma arteriotomy and why
transverse with healthy vessel
longitudinal if unhealthy and patch may be needed
How are sb hemangiomas dg and how should they be managed
CT IV
no intervention if asymptomatic
endo or IR can control bleeding
surgery if all else fails
2 most common sites for peripheral artery aneurysmsative sizes?
Pop then CF
2 and 2.5
CDH1 prophylaxis timing?
total gastrectomy 18-30 and screen like BRCA
what is the mc electrolyte abnormality in SBO
mechs?
so what type of fluid are you giving
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
MCC of intussusception in adults
Ca
4 common bugs in SB overgrowth
4 structures that predispose
streptococci, bacteroids, Escherichia coli, and lactobacillus.
blind loops, fistula, larg divert, stricture
what can be seen on cbc for SB overgrowth patients and why?
B12 deficiency due to bacteria overconsumption
testing for sb overgrowth
imaging?
labs?
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.
non op tx for sb overgrowth
MOA and duration
rifaximin
DNA dep RNA poly; 14 d
supplements for blind loop patients
B12 and med chain FA
2 most important surgical anatomy factors in optimizing short gut
how do these help
keeping IC valve and ileum
ICV allows for transit control
Ileum absorbs ADEK, B12 and bile acids; most adaptable
compare ileum and jejunum
4 instances of TPN failure in short gut
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
absolute contraindication to SB transplant
Active infection or malignancy
3 long term complications with short gut outside of intestine
Calcium oxalate kidney stones and gallstones
Hepatic and biliary disease
Metabolic bone disease
alternate PE findings for appendicitis
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).
For appy, what causes luminal obstruction in kids v adults
MALT v fecelith
median age of appendicitis
28
assoc disease with appy
CF
Appy ddg in women
pelvic inflammatory disease, adnexal cysts, ovarian torsion, ectopic pregnancy, or a tubo-ovarian abscess should be considered.
percent of pop with appy
6%
All the appy PE signs
negative appy risk for pregnancy
Negative appendectomy is associated with a 4% rate of fetal loss and a 10% rate of early delivery.
considerations in interval appy
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.
Lap appy risk %s
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.
Describe toxigenesis of C diff
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.
What hx should be asked if concern for c diff
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.
first line test for c diff; whats the issue
next?
stool toxin, false negatives
NAAT — looks for gene encoding toxin B
concerning colonic measurements in c diff
colon> 6cm
cecum>12
2 labs for severe c diff
15k wbc or 1.5 cr
what may be a harbringer of worsening c diff colitis?
this is secondary to….
worsening ileus; colonic atony
mortality and stoma reversal rates with c diff colectomy
preferred operation?
Mortality rates for C difficile colitis requiring surgery are greater than 50%.
Stoma reversal rates are less than 35%.
total
recurrent c diff recs: 1st 2nd 3rd
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.
inpatient acute c diff colitis mild, severe and fulminant medical txs
what if ileus is present?
mild: oral vanc or fidaxomycin
sev: same
fulm: oral vanc and IV metro
rectal vanc enemas for ileus
tracking for C diff incidence
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).
What therapy is given after all mastectomies and lumpectomies?
What are the benefits?
WB rads
dec local rec
inc survival
4 patients that cant get breast cons therapy for DCIS
1st tri preg
diff pos margins
small breasts
diffuse susp calcs
MC complication of PEG tube
infection
Tx for any solid intratesticular mass?
radical orchiectomy
What are the 3 antigen presenting cells and which one predominates
Dendritic
mp, B cell
kupffer cells
liver Mps
NK cells attack cells that lack what
MHC1
IL for B cells
4
Reboa zones and where not to occlude
Single bx for barretts confirms high grade, what now
tx
4 quad bx every 1 cm
EMR
MCCx of hemorrhoidectomy and why
urinary incontince
-ivf
-pain irritating nerves
-adv age
Signs concerning for primary graft non function for liver tx
tx
re trans
First line tx for acute rejection of transplant
2nd?
steroids
anti-thymocyte globulin
Mondor dis primary cause
secondary?
idiopathic
trauma, iatrogenic, infection, ca, hypercoag, vasculitis
MCC of suppurative jugular vein thrombo
pharyngitis
Dg imaging for colovesical fistula
CT
MC side of dissection in type B
posterolateral
Gastric NET endoscopic resection cutoff?
2cm as 10% nodal mets at that point
tracheal injury mng:
1. small anterior defects
2. transection(howmany rings can be lost?)
3trach?
- simple transverse
- 6
- Devastating injury
positive predictors for successful reflux surgery
typical gerd signs
demeester appropriate
good response to ppi
ca in celiac patients
enteropathy assoc t cell lymphoma
MCC of liver failure in US?
tx?
acetam
n-acetyl
do i have to tell patients im HIV pos?
not legally, but ethically
MC long term sequelae of ileal pouch
pouchitis
preferred graft type in sma bypass
PTFE
measurement cutoffs for arteries and veins for fistula formation wrist?
upper arm?
2mm artery and 2-3mm veins
3?
rule of 6s for av fistula formation
When can a pregnant woman get rads for breast ca?
what would she receive otherwise if operative
2nd and 3rd
simple mastectomy and SLNB
What is the proven benefit of a trach
less sedation to aid in weaning
3 mechs of PTH ca inc
- osteoclast stim
- stim calcitriol(VD) formation
- DCT rabsorb in kidney
3 MC bugs in SBT
e coli, kleb, pneumococc
Most important vitamin in wound healing
3 mechs
collagen cross linking
makes hydroxyproline
stabilizes collagen
what is a positive apnea test?
pCO2 rises to 60 off vent
combined invasice breast ca and DCIS tumor margin rules
negative ink is good
why 2mm for DCIS
skip lesion
location for thoracentesis
8th midax and mid scap
In patients with hematochezia and hypotn what must be ruled out
UGIB
absolute indications for dialysis
relative?
uremic pericarditis, pleuritis, encephalopathy
AEIOU
mid shaft humoral fracture is associated with what nerve injury
radial
radial , median and ulnar distal ue motor actions?
radial - thumb and wrist ext
median thumb and wrist flex
ulnar - all pinky stuff
early vs late graft infection bugs
aureus vs epidermidis
2 parts of treatment for TTP?
steroids and plasmapheresis
give new ADAMTS3 while suppressing further destruction by immune system
2 GIST grade determinants
when should warfarin be bridged for surgery concerning AF stroke risk
what trial supports this
CHADSVASC of 3
BRIDGE trial
MCC hepatits in west vs east
Western is B
Eastern is C
Do any superficial vein thrombi need anticoag?
3 cm from saphenousfemoral junction
epithelial ovarian tumor marker
CA 125
MCC of liver failure in
US v world
acetam vs viral
prosthetic vs mechanical benefit
downside
MCC of death for both
no long term anticoag
dont last as long
CHF
4 genetic syndromes involving PNETs
VHL, MEN1, NF1, tuberous sclerosis
dominant cell type in proliverative phase
fibroblasts
what is the max tensile strength after wound healing
80% at 6 weeks
what effect do myofibroblasts have on wound
contraction
MCCx of ERCP
pancreatitis
MC site of renal mets
lung
3 high risk CV surgeries; overall % risk
aortic, major vasc, periph vasc
> 5
Which toxin for C diff causes intestinal necrosis
A
lymphangitis abx?
clindamycon
3 expected lab findings post splenectomy
mild leuko
thrombocytosis
howell jolly and targets
critical limb ischemia ABI
0.5
When to perform endoscopic ultrasound for panc cyst?
large symptomatic splenic cyst treatment? size cutoff
surgery
5cm
what would keep one from doing combined liver and colon resections?
symptomatic, multi segmental, or complex rectal surgery
3 risk factors for spontaneous retroperitioneal hemorrhage
old, antiplatelet and renal impairment
What is the borderline gallbladder polyp size and when should this class be removed?
What size always comes out
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
complete surgical management of gallstone ileus?
ONLY enterostomy
what is the benefit of lap vs open inguinal for cirrhotic patients
less bleeding
Go to surgery for femoral hernia repair if able to reduce
lap
What should you do for a preg lady with symp stones recurring in the 3rd trimester
operate
IVF strategy for pyloric stenosis baby
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
Size cutoffs for pyloric stenosis
3mm and 15mm
2 required investigations prior to fundo for GERD
what is accessory if above positive for gerd
EGD and manometry
ph test
Thiamine deficiency s/s?
B12?
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
If a roux comes in with tachycardia…..
explore!
Tx for ilecolic anastomosis stricture in crohns
dilation
next step for esoph adeno if mass cant be traversed with scop
PET/CT
screening guidelines for barretts
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).
surveillance sched:
barretts
lgd
hgd
3-5y
1y or ablation
EMR
HGD barretts ca risk annually
7%
only thing that improves lap insufflation pain
lower pressure
duodenal polyp findings and improtance for risk
Extremely dense breast tissue is a ___ relative risk for breast cancer in this age group
2
40-49
what lifetime risk indicates annual MRI for breast cancer?
20%
preferred imaging modality for neoadjuvant follow up for breast cancer
mri
higher incidence of what comparing autologous to implants for breast rocon
periop complications
calcification descriptions and their risk %:
rim -
linear
round -
dystrophic
rim - <2
linear -2-95 (78)
round - <2
dystrophic -<2
4 high risk calcification appearances
linear, pleiomorphic, coars heterog, amorphous
benign sounding calcifications
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.
granulomatous mastitis tx
steroids or MTX if needed
indications for genetic testing for breast cancer
stromal fibrosis on core needle in breast, next step if concordant with rads
follow up imaging
`follow up after stage 2 breast full treatment
annual mammogram
screening sched for brca
annual MRI at 25 and mammos plus mri at 30
rec BSO
+/- bpm
what receptor status is eligible for gene expression assay in breast
what is this hlepful for
ER+
adj chemo decisions
How to fundo a sleeve
Hill esophagogastropexy – lesser curve to MAL
highest risk post transplant ca
SCC of skin
When to do Delorme
small less than 5cm without strangulation
on what aspects of the arm are fasciotomies performed, what structure is included
volar and dorsal with carpal tunnel release
4 TASC c lesions
most common site of CRC recurrenc ranked
liver, lung, local
Go to HIPEC drug
MOA
mytomycin
crosslinks–damages DNA syynth
what is the new tissue involvement for stage 3 sacral ulcer
subcut fat
first step in colonic pseudo obstruction workup after CT
Tx
barium enema
neo
most sensitive imagin modality to detect small liver mets
IO u/s
Explain TBI categories
associate vit deficiency 2/2 carcinoid syndrome consumption of tryptophan
s/s?
B3 - niacin
derm, dem, diarrhea
what is recycled in the Cori cycle
what metabolic state is the patient in
lactate and pyruvate to glucose
starvation
Newest rec for peds bleeding diverticula?
exceptions?
neoplasm, ischemia, or wide base
heller myotomy rule
5 up 2 down
what causes skin changes in inflam breast ca
tumor cells in lymphatics
When does the radical cholec upgrade given T stage and what to
T3 through serosa
needs full segmental 4b 5
inc ICP triad
2 accessory symptoms
cushings: bradycardia, resp depress, htn
6th crania nerve palsy – lateral rectus weakening blurry vision
pain
bladder pressure for ACS
20
peripheral nodular enhancement in liver imaging means
hemangioma
Differnetiate the CT findings for benign liver tumors
next step for panc fistula if output persists
stent and sphincterotomy
risk of strangulation for femoral hernia
45%
MC STV in US
condyloma accuminata
what is the known benefit of closing fascia for laparoscopic hernia repair
seroma dec
severe short bowel medication and effects
GLP2 – mucosal growth
imaging for breast mass in man
u/s and mammo
MCC of goiter and hypothyroidism>, also called
abs?
Hashimoto -chronic lymphocytic thyroiditis
thyroid peroxidase ab, throglobulin abs
MC site for GI NET? followed by….
rectum then SB(ileum)
MC panc adeno oncogene
KRAS
what thyroid cancer spreads hematogenously
follicular
Nigro protocol total duration? What happens at the end?
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
What causes amaurosis fugax in carotid stenosis
opthalmic artery blockage on same side
When can spleen be preserved with pancreatic cancer?
low risk tumors, NOT adeno
MEN 2 A components
oncogene
primary hyperthyroid
pheo
medullary
RET
N2 colorectal
4 or greater nodes
MArgins for Phyllodes
1cm
medial pectoral nerve innervates…
lateral?
both
pec major
MC undelying mass for bloody nipple discharge
intraductal papillomas – excise them
MCC of OPSI
strep pneum
5 melanoma bx markers
HMB
Malan A
SOX10
MITF
S100
drainage amount throshold for biloma ERCP and stent
300cc/d
ALH lifetime risk inc
4 fold
pre op ekg algorithm
3 meds that can cause gynecomastis
dig, theoph, and tiazide
MCC of massive hemothorax
mortality per repair type?
lung laceration
dg of gastric band erosion stable v unstable
endo
ugi
ovarian vein thrombosis tx
anticoag, abx
preferred pregnant or malignancy induced dvt tx
NOAC cxs? relative?
lovenox
child c, breast feeding
renal, sev obese, child a or b
what was the suture size in STITCH
2-0
olaparib is rec for what cancer
TNBC wutg BRCA
MC minor salivary tumor/
malign rate?
where?
adenoid cystic
high
hard palate
duration of provoked dvt tx
3m
what dens fracture needs operation
Type 2
histology descriptions of radial scar, inflam bc, pagets eczema, and phyllodes
5 half lives of a drug is now at what % of the final steady state
97%
inheritance pattterns of Menin and RET
AD
ADEK deficiency effects
SE deficiency
cardiomyopathy
Zn deficiency
growth fail, skin lesions
hypo phos
bone pain
Cu deficiency(5)
anemia, neutropenia, pigmentation, arrythmias, bone
Chromium deficiency
diabetes like
mc adrenal met
lung
MC presentation of primary hyperaldosteronism
bilateral hyperplasia
blair incision
posterior hip dislocation associated injury
sciatic
Appy carcinoid rules
MCC of upper lip v lower
basal
squamous
what big part of an sma embolism ex lap go first
revasc
first step in looking for accessory spleen
sulfur colloid
histologic description of fibromuscular dysplasia
thickening of media with collagen formation
tamoxifen actions
estrogen antagonist but agonist in all other tissues
leads to DVt and endometriosis
meperidine SE
seizures
internal mammary artery is a branch of the _____
subclavian
hydrofluric acid burns are treated with ______
calcium
watery diarrheal metabolic acidosis make up
hypochloremic and hypokalemic
when to pre-emptively band varices
> 5mm in Child B or C
biliary obstruction effects what vitamins
ADEK
Ketamine dosing
0.5-1 mg/kg – analgesic
1-2 — sedation
Now the preferred method for retained foreign body check
wand
Go to STSG donor site dressing
WET
current state of TXA
within one hour for GCS 15-9
or prehospital severe
no increase in DVT
What is TRALI similar to? how are they different
TRALI v TACO
ARDS, timing
pulmonary vs cardiogenic overload
what is the overall message with DECRA vs RESCUEicp
3 v 10 days refractory icps
late tx with decompressive craniotomy is better
go to dg modality for depth of injury after caustic ingestion
CT
what are the CT findings for adrenal carcinoma
overall mng?
what is a high risk lesion
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
adjuvant therapy for adrenal Ca
mitotane
tx of fistula with minor sphincter involvement
fistulotomy primary
causes of end tidal CO2 drop intraop
PE
MI
technical
bronchospasm
risk for TRAM flap-
obesity
best pos prognosticator with CRC w/ liver mets
response to neo
VTE regimen for colorectal ca post op patients
4week
what is a striking feature of this abscess
amaebic abscess if hx fits
simple septation
milrinone moa
PDE 3 — inc cardiac contractility
Endo AAA repair sizing rules:
prox neck length and diam
iliac landinzone and diam
take off angle
15mm; 17-32mm
20mm; 7-20
60 degrees
Treatment of LAMN with mucin pooling after appy
go straight to debulkign and hipec, no right hemi
fecal dna test needs to be done how often
3y
Haggit classification is irrelevent if ……
what is the Haggit classification at which formal resection is indicated
poor diff, high grade, LV invasion, PN invasion
4– bowel wall submucosa
Sessile polyp classes and which one can be watched
SM1 with less than 50% horizontal spread —- no high risk features
always do this after resection of small gastric polpys
get bx of normal tissue in several spots
Shallow anorectal fistula management
primary fistulecotmy
what is mechanical bowel prep good for
air leak test?
SSI
anastomotic leak
worst prognostic factor for gastric adeno
proximal location, increased depth and nodes
MLH1 and PMS2 + BRAF =
sporadic CRC
bad size and bad depth for rectal NET
what is this T stage usually
2cm; MP
T2
treatment for post hiatal hernia repair GOO due to vagal nerve injury
per oral pyloromyotomy
colonic lymphoma managment
surgery the CHOP
GIST vs leiomyom vs NET histo
when would we need to differentiate these
c Kit
Spindle with desmin
spindle without desmin
SM mass in rectum or esophagus
Layers of the esophagus and treatments per the level of esoph adeno involved
muc -EMR or esoph
sm - esoph
musc - neo and esoph
internal anal sphincter vs ext location
GS for esoph nodal staging
us
MC type of intussuseption
ileocolic then ileoileocolic
where does the lateral PJ for a peustow end?
start of head to tail
when can a fem pseudo be obs
less than 2cm
what is the new parkland formula
target uop in peds v adults
Brooks 2 instead of 4 x % x /mlkg
1/2 first 8h then 1/2 16 h
0.5-1 vs 1-1.5
mc met site for phyllodes
lung
mc sign for endometrial ca
demo?
vaginal bleeding
marasmus?
diff with kwashiorka?
total calorie proetein wasting
no edema or ansarca
when are thyroidectomies in the MEN classes now
2A - 5y
2B -1y
What is the only cdiff operation
total w/ end
80% of polyp will take this long to turn into CRC
What type are the other percent and what gene is involved
10y
sessile serrated, BRAF
time limit for thrombosed hemorrhoid excision
48h
rectal net size and layer cutoff for LAR
2cm, SM
anal squamous cell ca virus
hpv16
surveillance colonoscopy guidelines
4 pos indicators for pos margins in stomach adeno
> 5cm, signet cells, adv T stage, prox location
if CT not confirmatory for CRC met then what is next
MRI
rec for uncomplicated divericulitis in transplant patients
rec for low dose steroid CR anastomosis in post transplant
obs
ok to do
What is the pref op for dysplasia found in a long time UC pt
what would alter this course and how
total procto
total abdominal alone if malnutrition or severe illness present
benefit of total neoadjuvant for rectal vs neo and adj
less toxicity
who gets neo for rectal ca
what defines stage 2
stage 2 and up
past the MP to mesorectal land
does perforation matter if all other characteristics are ok for appendiceal carcinoid
na dawg
what does basal cell look like
MC skin cancer
basal cell
Precursor lesion for second most common skin cancer
actinic keratosis
neuroendocrine cell skin cancer
how to stage
how to treat
Merkel cell
PET
WLE w/ SLNB
excisional margins for non melanoma cancers
4-10mm margins
scc on burn
marjolin ulcer
merkel cell margins
adjuvant
1-2cm
rads
merkel cell pic
subungal melanoma tx
SLNB?
amputation
yes if greater than 1mm depth
lymphangitis bug
strep pyogenes
fournier
ecoli, entero, kleb
concerning signs of soft tissue mass malignancy
fixed mass, painful mass, increased size (> 3 cm), and depth of mass within the extremity compartment
desmoid recurrence rate
50%
what sarcomas get rads?
adj chemo?
5cm, high grade
stage 3 pelvic/rp
pediatric blood bolus calculation
10-20 ml/kg
carboxyhb tx
high flow oxygen
bacitracin use?
SE?
2nd degree
nephro
mupirocin?
SE?
staph infection
irritaiton
silver sulffadizaine
SE
third deg bruns with gram neg coverage
neutropenia and thrombocytopenia
mafenide
3rd deg; pseudo, eschar
met acidosis
silver nitrate SEs
cx in ..
methhemoglobinemia, hyponatremia/cl/k/ca
g6pd def
hypothermia classes and treattment
frostbite initial treatment
warm body, warm water, drain clear blisters
skin graft type for joints
full thickness
malignant bowel obstruction alternative from surgery
decompressive G tube
which is the mens BRCA
2
what anal fissure medication causes headaches
nitrates
preferred flap for irradiated APR defect
RAM flap
hawthorne bias
they know they are observed
berkson bias
chosen population is not generalized(only inpatient for ecample)
pygmalion effect
researcher opinion bias
paired v unpaired test
2 groups
before and after one treatment
2 separate txs
chi square?
2 groups categorical outcomes
ANOVA?
before and after continuous with more than 2 groups
