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TrueLearn All Flashcards

1
Q

What is nodular lymphoid hyperplasia?

A

numerous polyps in the small and large intestine associated with immunosuppression (tumors, IgA deficiency, HIV)
colorectal- not associated with malignancy
small intestine - associated w increased incidence of lymphoma

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2
Q

What are guidelines for placing an ICP monitor w severe brain injury?

A
  • GCS = or <8 who EITHER
    1. abnormal CT OR
    2. normal CT with >2 of following: age >40yrs, any hx of hypotension, abnormal motor posturing
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3
Q

equation for CPP

A

CPP = MAP - ICP

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4
Q

Name 4 etiologies of chylous ascites

A
  1. Malignancy- end stage pancreatic cancer
  2. Congenital Lymphangiectasia
  3. Thoracic duct obstruction
  4. Lymph peritoneal fistula
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5
Q

what is the most common causative organism of necrotizing fasciitis?

A

group A strep

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6
Q

What is the indication for a SLN bx in malignant melanoma?

A

primary melanoma = or >1mmm thickness and clinically negative nodes (for those 0.75 to 1.0mm, consider SLN in younger pts, evidence of ulceration or LVI, extensive dermal regression, or 1 or >mitosis/mm2)

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7
Q

tumor lysis syndrome occurs most often in what 2 cancers?

A
  1. Acute leukemia with high WBC counts

2. High grade lymphomas

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8
Q

what are 3 patient risk factors for tumor lysis syndrome?

A
  1. Bulky tumors sensitive to chemo
  2. Elevated LDH
  3. Renal insufficiency
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9
Q

what is the most common surgical option for SMA syndrome?

A

duodenojejunostomy

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10
Q

When repairing umbilical hernias, for what size defect do you place a mesh?

A

> 3cm defect

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11
Q

MOA of succinylcholine

A

nicotinic acetylcholine receptor agonist -> depolarization of the motor end plate

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12
Q

what are 5 side effects of succinylcholine?

A
  1. Hyperkalemia
  2. Muscle pain
  3. Transient ocular HTN
  4. Anaphylaxis
  5. Malignant hyperthermia
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13
Q

what are 3 contraindications to use of succinylcholine?

A
  1. Neuromuscular disease
  2. Closed head injury
  3. Burns
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14
Q

treatment of malignant hyperthermia?

A

dantrolene

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15
Q

what are the indications for elective repair of a AAA?

A

> 5.5cm or growing >0.5cm per 6 months

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16
Q

what is the most common indication for parotidectomy?

A

neoplasm

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17
Q

what is the problem with an ascending end colostomy?

A

leaves an end of the colon undrained leading to septic complications or perforation

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18
Q

serious side effect of neostigmine

A

bradycardia

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19
Q

Five Types of choledochal cysts

A

Type I: fusiform/saccular dilation of some or all extrahepatic ducts
Type II: isolated diverticulum protruding from the wall of the CBD
Type III: arises from intraduodenal portion of CBD
Type IV: multiple dilatations of either both the intra and extrahepatic ducts (A) or only the extrahepatic ducts (B)
Type V: Caroli’s disease: multiple dilatations limited to the intrahepatic bile ducts

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20
Q

treatment of type I choledochal cyst?

A

excision with roux-Y hepaticojejunostomy

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21
Q

treatment of type III choledochal cyst?

A

marsupialization or excision of the cyst

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22
Q

treatment of type II choledochal cyst?

A

excision and primary closure of the choledochotomy

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23
Q

what is thrombotic thrombocytopenia purpura? (classic pentad)

A

aka moschcowitz syndrome, widespread thrombosis of arterioles, pentad:

  1. Thrombocytopenic purpura
  2. Neurologic manifestations due to microvascular disease in the brain
  3. Kidney injury or hematuria
  4. Hemolytic anemia
  5. Fever
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24
Q

what is immune thrombocytopenia purpura

A

auto antibodies produced against platelets with resultant platelet destruction and thrombocytopenia

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25
Q

what is felty syndrome?

A

autoimmune neutropenia

triad of: rheumatoid arthritis, neutropenia, splenomegaly

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26
Q

what is wiskott-aldrich syndrome? (triad)

A

hereditary X linked disease

  1. Low platelet counts
  2. Combined B and T cell deficiency
  3. Eczema
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27
Q

what is the composition of lactose?

A

glucose and galactose

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28
Q

what is the composition of sucrose?

A

glucose and fructose

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29
Q

what is the composition of maltose?

A

glucose + glucose

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30
Q

what is budd chiari syndrome? how do you diagnose it?

A

hepatic venous obstruction- can be seen in hyper-coagulable states
diagnose: duplex US

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31
Q

What is WAGR syndrome?

A 
-deletion of chrom 11
Wilms tumor
Aniridia
GU abnormalities (cryptorchidism, streak ovaries)
Retardation (mental)
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32
Q

what chromosome is associated with WAGR syndrome?

A

deletion of short arm of chrom 11

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33
Q

most common organ to become injured in pediatric blunt trauma patients

A

jejunum and ileum

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34
Q

what is local recurrence rate for rectal adenocarcinoma after total pelvic exenteration?

A

3-8%

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35
Q

what are the different stages of hypothermia?

A

mild: 90-94F, shivering, tachy
moderate: 84-89F, agitation and combative, a fib and hypotension
severe: 70-84F, prolonged QRS and osborn waves, vfib
profound: <70F, loss of vitals

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36
Q

what is cullen sign?

A

evidence of retroperitoneal hemorrhage w blue around umbilicus

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37
Q

what is grey turner sign?

A

evidence of retroperitoneal hemorrhage w blue at flank

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38
Q

what is fox sign?

A

evidence of retroperitoneal hemorrhage with blue at the inguinal area

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39
Q

What is the definition of severe acute pancreatitis?

A
  1. necrosis of greater than 1/3 of pancreas

2. multiple organ failure (see hypotension SBP<90, renal failure (Cr >2.9), GI bleeding, resp failure (PaO2<60))

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40
Q

what are risk factors that predict poor survival in patients with hepatic mets from colorectal cancer? (5)

A
  1. node positive primary tumor
  2. disease free interval <12 months
  3. multiple liver mets
  4. largest hepatic met >5cm
  5. serum CEA >200
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41
Q

what study is the gold standard for evaluation of a AAA?

A

CT angiogram

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42
Q

what is the major cause of pyogenic liver abscess?

A

cholangitis, 2/3 of pathogens are gram negative aerobes

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43
Q

GIST: what is most prognostic factor to determine odds of recurrence? what is considered to have a high risk of aggressive clinical behavior?

A

Number of mitoses per HPF and tumor size
Aggressive behavior:
- >5cm with mitotic ct >5/HPF

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44
Q

what are the two types of proteolytic enzymes secreted by the acinar cells of the pancreas?

A
  1. Endopeptidases (trypsin and chymotrypsin- act on internal peptide bonds of proteins/polypeptides)
  2. Exopeptidases (carboxypeptidases- act on free terminal ends of proteins)
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45
Q

when should you consider a femoral aneurysm for operative repair?

A

when they reach 2.5cm in diameter

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46
Q

when should you repair a ventral incisional hernia with mesh?

A

> 4cm

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47
Q

what are the stages of ovarian cancer?

A

stage I: one or both ovaries only
stage II: extended involvement of tumor but limited to pelvis
stage III: involvement into the abdomen
stave IV: distant mets

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48
Q

what is the pathophysiology of flail chest and where does mediastinum shift?

A

during the inspiratory phase, the chest wall collapses in causing air to move out of the bronchus of the involved lung and into the trachea/bronchus of the uninvolved lung causing a shift of the mediastinum to the UNINVOLVED side (and then opposite during expiration)

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49
Q

4 epidemiological facts about gastric cancer

A
  1. 1.5-2.5 x M>F
  2. Incidence peaks in 70’s
  3. Blood group A more likely
  4. AA, Hispanic and native americans more likely
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50
Q

what is the suggested margin of resection for gastric adenocarcinomas?

A

5cm

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51
Q

whats the cattell brasch maneuver?

A

right medial visceral rotation (aka extended Kocher maneuver)
- provides access to the infrahepatic IVC, right kidney, right hilum, infrarenal aorta and iliac vessels

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52
Q

whats the Mattox maneuver?

A

left medial visceral rotation- mobilization of the descending colon to the midline to expose the abdominal aorta

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53
Q

whats the kocher maneuver?

A

dissection of the lateral peritoneal attachments of the duodenum to allow inspection of the duodenum, pancreas, and other RP structures over to the great vessels

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54
Q

how does the WHO classify colorectal tumors?

A

epithelial (adenoma, carcinoma, carcinoids)
non-epithelial (lipoma, leiomyoma, GIST, angiosarcoma, melanoma, Kaposi)
polyps (hyperplastic, peutz-jeghers, juvenile)
secondary

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55
Q

what are the basic anatomic requirements for EVAR? (5)

A
  1. aortic diameter <32mm
  2. Neck angle <45 to 60 degrees
  3. Neck length at least 10mm
  4. Iliac diameter at least 7mm
  5. Lack of thrombus or calcification
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56
Q

what is congenital lobar emphysema?

A

overdistention of one or more lobes within a histologically normal lung due to abnormal cartilaginous support of the bronchus causing air trapping and increase in lobar distention
if in resp distress- immediate thoracotomy w resection

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57
Q

how often should u do surveillance EGD in a pt w familial polyposis?

A

every 1-2 years

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58
Q

how often should u do surveillance EGD in a pt w esophageal varices s/p banding and sclerotherapy?

A

every 6-8 weeks

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59
Q

how often should u do surveillance EGD in a pt w gastric ulcer?

A

every 6-8 weeks until ulcer healed

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60
Q

how often should u do surveillance EGD in a pt w barretts esophagus low risk (short segment <3cm)?

A

every 2 years

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61
Q

how often should u do surveillance EGD in a pt w barretts esophagus high risk (long segment (>3cm), circumferential)?

A

every 1 year

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62
Q

how often should u do surveillance EGD in a pt w barretts esophagus (high risk w low grade dysplasia) ?

A

every 6 months

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63
Q

what is the minimum number of lymph nodes required for accurate staging of colon cancer?

A

12

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64
Q

what is the predominant artery supplying blood to the hand?

A

ulnar artery

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65
Q

what artery supplies the superficial palmar arch?

A

ulnary artery

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66
Q

what artery supplies the deep palmar arch?

A

radial artery

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67
Q

what is reynolds pentad?

A 
fever
jaundice
RUQ pain
shock/hypotension
AMS
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68
Q

what is the pringle maneuver and what structures does it occlude?

A

clamping of the portal triad via clamping of the hepatoduodenal ligament

  1. portal vein
  2. hepatic artery
  3. common bile duct
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69
Q

what effect do omega 3 fatty acids play in the perioperative period? 3

A
  1. Modulation of leukocyte function
  2. Regulation of cytokine release
  3. Accelerating the resolution of the proinflammatory state
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70
Q

what role do omega 6 fatty acids play in the periop period?

A
  1. associated w higher inflammatory response
  2. precursors to leukotrienes, thromboxane -> vasocontriction
  3. Induce platelet aggregation
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71
Q

give an example of an omega 6 fatty acid?

A

linoleic acid

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72
Q

give an example of an omega 3 fatty acid?

A

linolenic acid

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73
Q

what is the blood supply for the right colon?

A

via the SMA and include the ileocolic, right colic and middle colic (right branch) aa

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74
Q

what are the resection margins for colon cancer?

A

5cm on either side

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75
Q

how can you differentiate between nephrogenic and central diabetes insipidus?

A

DDAVP (central responds, nephrogenic does not)

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76
Q

what is central vs nephrogenic diabetes insipidus?

A

central: decreased secretion of ADH, usually due to injury to hypothalamus
nephrogenic: kidneys are resistant to action of ADH

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77
Q

what is the hallmark electrolyte imbalance in refeeding syndrome?

A

hypophosphatemia

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78
Q

What are the absolute contraindications to liver transplant? (3)

A
  1. Recent ICH
  2. CV/pulm issues wont survive surgery
  3. Untreated extrahepatic malignancy
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79
Q

most common cause of hemobilia?

A

iatrogenic trauma to liver/biliary tree

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80
Q

what does a V/Q of 0 represent

A

loss of ventilation aka shunting

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81
Q

what muscle must you divide to visualize the distal internal carotid?

A

digastric

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82
Q

manamagement of melanoma in situ? margins?

A

wide local excision with 0.5-1cm margins

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83
Q

incidence of post op gastroparesis in pts w partial gastrectomy and vagotomy?

A

2-3%

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84
Q

treatment of post op gastroparesis in pts w partial gastrectomy and vagotomy?

A

surgical tx w near completion gastrectomy and roux-en-y gastrojejunostomy

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85
Q

what is the pars-flaccida technique regarding gastric bands?

A

dissection through the fatty tissue posterior to the GE junction to create a tunnel in which the band sits, decreases incidence of band slippage

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86
Q

treatment for seminoma?

A

orchiectomy via an inguinal approach (do not biopsy or remove via scrotal approach to avoid disrupting the lymphatic drainage)

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87
Q

why dont you biopsy germ cell tumors?

A

will expose the tumor to the immune response

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88
Q

lab values seen in seminomas

A

normal AFP and RARELY elevated beta-HCG (90%normal level)

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89
Q

what is the preferred fuel source for enterocytes and immunocytes?

A

glutamine

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90
Q

what organism causes amoebic liver abscesses?

A

E. histolytica: non-flagellated pseudopod forming protozoan

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91
Q

how do amaebic trophozoites reach the liver in amebiasis?

A

fecal-oral transmission then mesenteric veins then portal vein to liver

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92
Q

what two hormones regulate secretion of pancreatic juice?

A

secrtin and cholecystokinin (CCK)

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93
Q

what is the composition of pancreatic fluid? (Na, K, Cl, HCO3)

A 
Na = 140
K = 5
Cl = 75
HCO3 = 75
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94
Q

amount of air moved in a normal breath

A

tidal volume

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95
Q

maximum volume of air that can be expired after a maximal inhalation?

A

vital capacity

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96
Q

the amount of air left after maximal exhalation

A

residual volume

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97
Q

the amount of air left after exhaling a normal breath

A

expiratory reserve volume

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98
Q

most common site of hematogenous metastasis of sarcomas?

A

lung

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99
Q

what is malignant fibrous histiocytoma?

A

type of sarcoma, most common type of soft tissue sarcoma of the extremity

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100
Q

which types of sarcomas would you want to obtain a CT of the abdomen? (aka most commonly metastasize to abdomen) 4

A
  1. myxoid liposarcoma
  2. epitheliod
  3. Angiosarcoma
  4. synovial sarcoma
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101
Q

how do you calculate the ABI?

A

divide the systolic blood pressure at the ankle by the systolic blood pressure in the arm

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102
Q

ABI range of pts w claudication

A

0.7-0.9

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103
Q

ABI range of patients with rest pain

A

0.4-0.7

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104
Q

ABI range of patients with gangrene/wound complications

A

<0.4

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105
Q

what does fluid analysis show for IPMNs?

A
  • high viscosity
  • high CEA
  • high amylase
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106
Q

what does fluid analysis for serous cystadenocarcinoma show?

A
  • low viscosity
  • low CEA
  • low amylase
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107
Q

what does fluid analysis show for mucinous cystadenocarcinoma?

A
  • high viscosity
  • high CEA
  • low amylase
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108
Q

what age cutoff is used for surgical cricothyroidotomy in pediatric patients?

A

> 11yrs: surgical cric

<11yrs: needle cric w 14 or 16G needle or tracheotomy

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109
Q

proposed etiology of TRALI?

A

donor antibodies attack recipient leukocytes causing leaky capillaries and pulmonary edema

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110
Q

what is proposed etiology of transfusion related febrile illness?

A

host antibody response to donor leukocytes

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111
Q

treatment of leiomyomas <8cm without annular characteristics?

A

surgical extramucosal enucleation and subsequent closure of the myotomy
mid esophageal: right chest approach
lower esophagus: left chest or abdomen

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112
Q

treatment of asymptomatic esophageal cysts?

A

removal! even when asymptomatic due to risk of infection

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113
Q

management of benign appearing asymptomatic esophageal lesions?

A

observed with serial endoscopic US WITHOUT biopsy

- biopsy can increase risk of perforation at time of surgical enucleation

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114
Q

lidocaine:
speed of onset (min):
duration of action (min):
maximal dose (mg/kg):

A

speed of onset (min): 10-20
duration of action (min): 60-180
maximal dose (mg/kg): 4.5mg/kg

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115
Q

mepivacaine-
speed of onset (min):
duration of action (min):
maximal dose (mg/kg):

A

speed of onset (min): 10-20
duration of action (min): 60-180
maximal dose (mg/kg): 5mg/kg

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116
Q

Bupivacaine:
speed of onset (min):
duration of action (min):
maximal dose (mg/kg):

A

speed of onset (min): 15-30
duration of action (min): 180-360
maximal dose (mg/kg): 2.5mg/kg

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117
Q

lidocaine WITHOUT epinephrine max dose

A

4.5mg/kg

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118
Q

lidocaine WITH epinephrine max dose

A

7mg/kg

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119
Q

what is achalasia and how do you diagnose?

A

esophageal motility disorder w lack of peristalsis and failure of LES to relax
dx: manometry

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120
Q

what are the three main types of small intestine adenomas?

A
  1. villous
  2. tubular
  3. Brunners gland adenomas
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121
Q

what type of malignancy is associated with signet ring cells on pathology?

A

gastric cancer

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122
Q

what is the most common malignancy of the thyroid?

A

papillary carcinoma

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123
Q

what are the characteristic pathologic findings of papillary thyroid cancer?

A

orphan annie nuclei and psammoma bodies

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124
Q

buzzword: lateral aberrant thyroid tissue

A

think Papillary thyroid cancer!

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125
Q

what is the greatest risk factor for the development of gastric cancer?

A

H. pylori infection

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126
Q

most common side effect of topical silver sulfadiazine?

A

transient neutropenia

also thrombocytopnia

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127
Q

side effects of topical silver sulfadiazine?

A
  1. Neutropenia
  2. Thrombocytopenia
  3. methemoglobinemia
  4. Contraindicated in pts w G6PD deficiency
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128
Q

most common side effect of mafenide acetate? why?

A

metabolic acidosis

MOA: inhibits carbonic anhydrase leading to a metabolic acidosis

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129
Q

side effects of silver nitrate?

A

electrolyte disturbances:

  • hyponatremia
  • hypochloremia
  • hypocalcemia
  • hypokalemia
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130
Q

which topical burn rx penetrates eschar? which on does not?

A

penetrates: mafenide acetate

doesn’t: silver sulfadiazine

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131
Q

5 ligaments of the liver to diaphragm

A
  1. left coronary
  2. left triangular
  3. falciform
  4. right coronary
  5. right triangular
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132
Q

treatment of thyroid storm (4 drugs)

A
  1. PTU* (inhibits peripheral conversion of T4 to T3)
  2. Methimazole
  3. steroids
  4. Beta blocker
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133
Q

resting pressure of the LES

A

10-20mmHg

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134
Q

resting pressure of the upper ES

A

50-70mmHg

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135
Q

which two pelvic fractures are associated with bladder injuries?

A
  1. pubic diastasis

2. obturator ring fx

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136
Q

whats the strongest determinant of serum osmolarity?

A

sodium!

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137
Q

how do you determine serum osmolarity? (formula)

A

2xNa + Glucose/18 + urea/2.8

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138
Q

standard treatment of infants with biliary atresia?

A

Kasai Procedure: roux-en-y hepatic portoenterostomy

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139
Q

what is the kasai procedure?

A

roux-en-y hepatic portoenterostomy,

standard tx in infants w biliary atresia

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140
Q

what are the structures of the renal hilum from anterior to posterior?

A

renal vein, renal artery, ureter

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141
Q

when is FENa unreliable when diagnosing ARF?

A

in pts on diuretics

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142
Q

what are the nutrients for colonocytes?

A

short chain fatty acids

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143
Q

what is the puestow procedure?

A

longitudinal pancreaticojejunostomy: used in patients with severe symptomatic chronic pancreatitis

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144
Q

what is the Frey procedure?

A

coring out of the pancreatic head and a roux-en-Y pancraticojejunostomy

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145
Q

what is the Beger procedure?

A

resection of pancreatic head with a roux-en-Y jejunal loop as side-to-end and side-to-side pancreaticojejunostomy

146
Q

how are bladder lacerations repaired?

A

two layers using absorbable suture

1st: mucosa and muscularis
2nd: muscularis and serosa

147
Q

how is epinephrine synthesized from tyrosine?

A

Tyrosine -> L-dopa -> dopamine -> norepinephrine -> epinephrine

148
Q

biopsy of soft tissue tumor shows spindle cells and positive CD-34 staining

A

dermatofibrosarcoma

149
Q

what are the 3 types of gastric carcinoids?

A

type I: assoc w chronic atrophic gastritis, slow growing
type II: assoc w ZES and MEN type I, more likely to mets
type III: most biologically aggressive, frequently mets, not assoc w hypergastrinemia

150
Q

what type/duration of anticoagulation is required for drug eluting stents vs bare metal stents?

A

drug: 1 year of dual antiplatelet therapy then ASA forever
bare: 3 months of dual therapy then ASA forever

151
Q

how do you repair a tracheal injury?

A

single layer of interrupted absorbable sutures + tissue flap using strap muscle buttress

152
Q

what are 3 relative contraindications to lap chole?

A
  1. untreated coagulopathy
  2. gallbladder cancer
  3. frozen abdomen from previous surgery
153
Q

whats the difference between the Sengstaken-Blakemore and Minnesota tubes?

A

Minnesota tube has a proximal port that allows for drainage of salivary secretions

154
Q

what is the most accurate method of diagnosing portal hypertension?

A

hepatic vein pressure gradient = reflects hepatic sinusoidal pressure, diagnostic when >6mmHg

155
Q

when can you use punch biopsy when suspecting melanoma?

A
  • lesion >2cm

- over areas that are difficult to close (face)

156
Q

what are the 3 P’s of ZES?

A

Prolactinoma -> galactorrhea
PUD (refractory)
hyperParathyroidism -> hyprcalcemia

157
Q

what’s the vitamin or mineral deficiency?

poor glycemic control

A

low chromium

158
Q

what’s the vitamin or mineral deficiency?

pancytopenia

A

low copper

159
Q

what’s the vitamin or mineral deficiency?

sideroblastic anemia and peripheral neuropathy

A

vitamin B6/pyridoxine

160
Q

what’s the vitamin or mineral deficiency?

cardiomyopathy

A

selenium

161
Q

what’s the vitamin or mineral deficiency?

skin rashes and hair loss

A

zinc

162
Q

whats the origin of the phrenic nerve?

A

C3,C4,C5

163
Q

what organism causes emphysematous cholecystitis?

A

clostridium perfringens, seen in poorly controlled diabetics

164
Q

what part of the small intestine is responsible for fat soluble vitamin absorption?

A

ileum: ADEK

165
Q

classification of aortic dissections

A

type A: dissections proximal to the left subclavian aa (acute surgical emergency)
type B: distal to the left subclavian aa, usually medically tx

166
Q

difference in venous drainage of left and right adrenal veins

A

left: joins inferior phrenic vein and empties into the left renal vein
right: drains directly into the IVC

167
Q

what are the layers of the adrenal cortex and what do they produce?

A

GFR = salt, sugar, sex steroids
Glomerulosa: aldosterone
Fasciculata: glucocorticoids
Reticularis: androgrens/estrogens

168
Q

2 main functions of aldosterone

A
  1. Renal sodium reabsorption

2. Secretion of K and H ions

169
Q

difference between primary and secondary hyperaldosteronism

A
  • check Renin levels
    Primary: low
    Seconday: high
170
Q

what is conn’s syndrome?

A

primary hyperaldosteronism

  • HTN
  • hypokalemia
  • metabolic alkalosis
171
Q

what is Addison’s disease?

A

adrenal insufficiency -> hypocortisolism (ACTH will b high) and decreased aldosterone

172
Q

how do you test for Addison’s disease?

A

cosyntropin test: give ACTH, measure cortisol and it will still be low

173
Q

which chemotherapeutic agent is used for adrenocortical carcinoma?

A

mitotane: toxic for adrenocortical cells

174
Q

what is the “rule of 6’s” in regards to HD fistula access?

A
  • diameter of fistula should be at least 6mm
  • fistula should be at least 6mm below skin
  • flow should be at least 600mL/min
175
Q

what are the depths of invasion for esophageal cancer? T1a, T1b, T2, T3, T4

A 
T1a: mucosa (could perform EMR)
T1b: submucosa (NAC, esophagectomy)
T2: muscularis propria
T3: adventitia
T4: adjacent structures
176
Q

when can you follow branch duct-IPMNs?

A

when <3cm, asymptomatic, no cytology or imaging concerning for malignancy
- follow with serial cross-sectional imaging

177
Q

go through the components of GCS

A

dont be lazy… DO IT!

178
Q

when do you consider evacuation in a subdural hematoma?

A

when larger than 1cm with a MLS (perform within 4 hours)

179
Q

dose of mannitol for ICHs?

A

1g/kg

180
Q

what is the major source of energy during stress and starvation?

A

Fats!

181
Q

mutation in what structural protein is associated with Marfan’s syndrome?

A

fibrillin
autosomal dominant
FBN1 gene

182
Q

bile aids in the absorption of what vitamin?

A

vitamin K

183
Q

MOA and side effect of Promethazine

A
  • antiemetic thats inhibits dopamine receptors

- SE: tardive dyskinesia (tx w benadryl)

184
Q

What is Kehr’s sign?

A

left upper quadrant pain with referred left shoulder pain

- seen in splenic lacs

185
Q

name 5 medications that are associated with prolonged QT interval?

A
  1. Haloperidol
  2. Erythromycin
  3. Methadone
  4. Lithium
  5. Amiodarone
186
Q

how do you reverse plavix (clopidogrel)?

A

administration of pooled platelets

187
Q

treatment of hepatoblastoma in children?

A

resection + chemotherapy (NO role for XRT)

188
Q

What is the Nigro protocol and when do you use it?

A

Nigro: 5FU, mitomycin C + XRT
used: squamous cell carcinomas of the anus

189
Q

chemotherapy for colon ca w nodal disease?

A

FOLFOX =

5FU, Leucovorin, Oxaliplatin

190
Q

what is the triad of electrolyte abnormalities of refeeding syndrome?

A

Hypophosphatemia
hypokalemia
hypomagnesemia

191
Q

what are the boundaries of the inguinal canal?

A

roof: internal oblique and transverses abdominis
floor: inguinal ligament
ant: external oblique and transversalis fascia
post: conjoint tendon

192
Q

what are the contents of the inguinal canal? 3

A
  • ilioinguinal nerve
  • genital branch of the genitofemoral nerve
  • spermatic cord
193
Q

chemotherapy agent for GIST tumors and indications (4)

A

imatinib

  1. positive margins
  2. metastatic disease
  3. recurrence
  4. any tumor >3cm
194
Q

surgical management of GIST tumor of small bowel vs carcinoid small bowel?

A

GIST: segmental resection (no tumor on ink, do not go to lymph node)
Carcinoid: resection w full lymph node dissection

195
Q

what is the gilbert repair for inguinal hernias?

A
  • two layer mesh repair

- anterior mesh is sutured but posterior is placed in retromuscular space as a sublay

196
Q

where do most iatrogenic perforations of the esophagus occur?

A

level of the cricopharyngeal muscle

197
Q

management of carcinoids <2cm vs >2cm

A

<2cm: excisional biopsy alone

>2cm: APR or LAR

198
Q

what are the structures within hunters canal?

A
  1. superficial femoral aa and v

2. saphenous nerve

199
Q

which structures border hunters canal?

A

vastus medialis
adductor magnus
sartorius
adductor longus

200
Q

describe the process of absorption of vitamin B12?

A

intrinsic factor secreted by parietal cells of the stomach binds to vit b12, then is absorbed in the TI

201
Q

mediastinal masses, how do you classify and what do thy include?

A

posterior: neurogenic
middle: lung cancer and cysts
anterior: thymomas, teratoms, lymphoma and goiter

202
Q

what are the steps of skin graft healing?

A
  1. Imbibition: diffusion of nutrients
  2. Inosculation: alignment of capillary beds
  3. Revascularization: 5 days
203
Q

MOA dobutamine

A

purely beta-adrenergic
low doses = beta 1 (cardiac contractility)
high doses = beta 2 (vasodilation)

204
Q

What is light’s criteria?

A

determination of transudate vs exudate, exudative is:

  • pleural protein:serum protein ratio >0.5
  • Pleural LDH: serum LDH ratio > 0.6
  • Pleural LDH > 2/3 the upper limit of serum LDH
205
Q

What is exudative effusion

A

result from inflammation or neoplastic processes that causes leakage across capillary membrane (thus bigger proteins can leak across)

206
Q

examples of exudative effusion vs transudative

A

Exudative: lupus, esophageal perf, abscess, ARDS, pancreatitis, chylothorax, malignancy
Transudative: atelectasis, CHF, hypoalbuminemia

207
Q

what are the grades of liver lacerations?

A

Grade I: <10% hematoma, or <1cm tear
Grade II: 10-50% hematoma, 1-3cm deep lac
Grade III: >50% hematoma, >3cm deep lac
Grade IV: ruptured hematoma, or lac involving 1-3 couinaud segments
Grade V: >3 couniaud ligaments
Grade VI: hepatic avulsion

208
Q 
Breakdown of fluid produced each day:
Saliva: 
Stomach:
Biliary:
Pancreatic:
Small Bowel:
A 
Saliva: 1500mL
Stomach: 1-2L
Biliary: 500mL
Pancreatic: 500mL-1.5L
Small Bowel: 1.5L
209
Q

Location and function of Renin

A

JG cells of afferent arterioles in kidney

  • cleaves angiotensinogen to angiotensin I
  • causes increase in extracellular volume and BP
210
Q

action of angiotensin II

A

acts locally to increase vascular tone and BP

211
Q

what 4 things activate renin?

A
  1. Changes in arterial pressure
  2. Na delivery to macula densa
  3. Increased Beta adrenergic activity
  4. Increases in cAMP
212
Q

management of SCC of lower lip?

A

usually lower vermillion border, wide local excision with 3mm margin
- if advanced stage, add XRT

213
Q

what gene is most commonly associated with familial and long segment Hirschsprung’s disease?

A

RET proto-oncogene

214
Q

pathogenesis of meckel’s diverticulum

A

occurs when the omphalomesenteric duct fails to close during gestation

215
Q

management of incidentally found meckels diverticulum

A

children: resect
adults: leave alone

216
Q

management of hydatid cyst?

A

albendazole followed by surgical resection

217
Q

which two pathways regulate apoptosis?

A
  1. Extrinsic: binding of death receptors -> activation of caspase 3
  2. Intrinsic: protein regulated via mitochondria releasing protein C and activating caspases
218
Q

buzzword: corkscrew esophagus

A

diffuse esophageal spasm

219
Q

buzzword: birds beak on esophagram

A

achalasia

220
Q

staging of gallbladder cancer

A

T1a: invades lamina propria
T1b: invades muscle layer
T2: invades perimuscular connective tissue (but doesn’t go through serosa)
T3: perforates the serosa and/or directly into one adjacent organ/structure
T4: extends >2cm into the liver or into 2 or more adjacent organs

221
Q

what is the normal response to ACTH stimulation test?

A

give ACTH, wait 30-60minutes, measure cortisol level, if >18mcg/dL then its normal

222
Q

how do you diagnose cushings syndrome?

A

-24hr urine collection for urinary free cortisol excretion, normal values are <90mcg per 24hrs, cushings >300mcg

223
Q

treatment of pancoast tumor causing shoulder pain and weakness?

A

neoadjuvant radiation

224
Q

what is myasthenia gravis?

A

autoimmune disorder where antibodies are directed against acetylcholine receptors at the neuromuscular junction
sx: ptosis, diplopia, weakness w repetitive movements, fatigue

225
Q

where are first branchial cleft cysts located?

A

anywhere between the external auditory canal and submandibular area, close to the parotid gland and facial nerve

226
Q

where do you commonly find second branchial cleft cysts?

A

the most common lesions, arise in the mid to lower neck along the anterior border of the SCM close to the glossopharyngeal and hypoglossal nerves

227
Q

symptoms of hypermagnesemia?

A
  • loss of deep tendon reflexes
  • Flaccid paralysis
  • hypotension
  • AMS/Coma
228
Q

what electrolyte antagonizes the effect of magnesium on neuromuscular function?

A

calcium

229
Q

resection margin of colon cancer?

A

2.5cm

230
Q

at what tim period does a wound achieve its greatest tensile strength?

A

8 weeks (which is about 80% of its pre-wound strength)

231
Q

types of collagen in wound healing

A

initially type III then quickly replaced with type I

232
Q

which type of heart valve does NOT require anticoagulation?

A

bioprosthetic

233
Q

when should you perform cholecystectomy in pts w a GB polyp(s)?

A

polyps are common, resect if:
1. Single polyps
2. Size >1cm
and 3. Age >50

234
Q

differences in management between upper, middle and lower ureteral injuries

A

upper: debridement, primary anastomosis, stenting
middle: ureteroureterostomy
lower: reimplantation into the urinary bladder

235
Q

what are the borders of dissection for superficial inguinal lymphadenectomy?

A

lateral: sartorius muscle
medial: adductor magnus
superior: inguinal ligament

236
Q

what size of thyroid nodule dictates need for FNA?

A
  1. All solid nodules >1.5cm
  2. All Mixed Solid-cystic >2cm
    if suspicious sonographic features are present-
  3. Solid nodules >1cm
  4. Mixdd >1.5cm
237
Q

what are suspicious sonographic features of thyroid nodules?

A
  1. Hypoechoic nodule
  2. Infiltrative margins
  3. Increased vascularity
  4. Taller than wide
238
Q

where is the endarterectomy plane?

A

between the layers of the tunica media

239
Q

blood supply of the splenic flexure?

A

marginal artery of brummond

240
Q

what is the hill esophagogastropexy?

A

plication of the lesser gastric curvature around the right side of the esophagus and performing an esophagogastropxy to the median arcuate ligament (must use intraoperative manometry)

241
Q

what is the nissen fundoplication?

A

complete 360 degree fundoplication

242
Q

most common complication of popliteal aneurysm

A

acute limb ischemia

243
Q

what does merkel cell carcinoma usually stain for?

A

CK-20 (same as small cell ca of lung)

MCC is negative for TFF-1 and Small cell ca is positive

244
Q

what IHC staining differentiates small cell carcinoma of lung from merkel cell carcinoma?

A

Thyroid Transcription Factor-1 (TFF-1)
SCC is positive for it
MCC is not
both stain for CK-20

245
Q

most specific us finding for cholecystitis?

A

sonographic murphys sign

246
Q

which genetic abnormality is associated with MEN II syndrome?

A

RET proto-oncogene

247
Q

which genetic abnormality is associated with MEN I syndrome?

A

MENIN (encoded by the MEN1 gene)

248
Q

what approach to expose the left subclavian aa?

A

lateral thoracotomy

249
Q

what approach to expose proximal right subclavian aa?

A

median sternotomy

250
Q

which cytokines are responsible for proliferation of B lymphocytes?

A

IL 2,4,5,6,7

251
Q

what is function of IL-2?

A

released by T cells and promotes T cell proliferation, B cell proliferation and in vitro antibody production

252
Q

what cytokines are released from T cells and promote proliferation and maturation of B cells?

A

IL 4,5,6

253
Q

What is the function of IL-7?

A

produced by the bone marrow and is essential for stimulation of hematopoietic stem cell differentiation into both B and T cells

254
Q

What is the function of TGF-beta?

A

inhibits T and B cell proliferation

255
Q

whats the cause of post transplant lymphoproliferative disorder?

A

Proliferation of EBV positive B cells (can cause a mononucleosis like illness)

256
Q

what are the only essential fatty acids?

A

linoleic and linolenic (unsaturated, cis-configuration)

257
Q

what is the expected excess weight loss after 2 years of lap band?

A

40-55%

258
Q 
what are the estimated weight loss for the following procedures:
lap band:
sleeve gastrectomy:
gastric bypass:
duodenal switch:
A

lap band: 40-55%
sleeve gastrectomy: 55-70%
gastric bypass: 60%
duodenal switch:70%

259
Q

what muscle is divided when creating a diverting loop ileostomy?

A

rectus abdominis

260
Q

when you create a loop ileostomy, what layer is used to secure it to the skin?

A

seromuscular bites!

261
Q

treatment of carotid body tumors?

A
  1. CT angio for operative planning

2. Excision of just about all tumors! if pt cant tolerate surgery then XRT, if >3cm then embolize the day before surgery

262
Q

management of necrotizing pancreatitis?

A
  1. FNA to evaluate for bacteria
  2. percutaneous drainage if bacteria present
  3. if still deteriorating then endoscopic/lap drainage
263
Q

what does the prothombin time (PT) measure?

A

extrinsic pathway of the coagulation pathway: Factors I, II, V, VII, and X

264
Q

what does the aPTT measure?

A

the intrinsic pathway of the coagulation cascade: Factors I, II, V, VIII, IX, X, XI, and XII

265
Q

what factor differentiates the intrinsic and extrinsic coagulation pathway?

A

factor VII is part of the extrinsic (PT) but not the intrinsic (aPTT)

266
Q

intraoperative hypertension from pheochromocytoma is managed w what?

A

sodium nitroprusside drip

267
Q

what are the boundaries of a central lymph node dissection?

A

superior: hyoid bone
inferior: innominate artery
lateral: carotid arteries

268
Q

what is bowen’s disease?

A

high grade squamous intraepithelial lesion (basically squamous cell carcinoma in situ), <10% chance to progress to invasive SCC, local excision

269
Q

which velocities are indicative of the differing carotid stenoses?

A

Stenosis <50%: <125cm/s
Stenosis 50-69%: 100-230cm/s
Stenosis >70%: >230cm/s

270
Q

what suture is used to repair aorta?

A

permanent: polypropylene

271
Q

what also must be performed during distal pancreatectomy for malignancy?

A

splenectomy (dont need to do this for benign or traumatic disease)

272
Q

order of EKG changes in hyperkalemia?

A
  1. peaking of t waves
  2. widening of QRS
  3. widening of PR interval
  4. disappearance of p wave
  5. rhythm turns into a sine wave
273
Q

characteristics of MEN I?

A
  1. parathyroid hyperplasias
  2. Pancreatic islet cell tumors
  3. Pituitary adenomas
274
Q

characteristics of MEN IIa?

A
  1. Medullary thyroid cancer (often bilateral)
  2. Pheochromocytomas (often bilateral)
  3. 4 gland parathyroid hyperplasia
275
Q

characteristics of MEN IIb?

A
  1. Medullary thyroid cancer
  2. Pheochromocytomas
  3. Neuromas
    + marfinoid habitus
276
Q

first line imaging for carotid disease?

A

duplex US

277
Q

what are the three types of small intestine adehomas?

A
  1. Villous
  2. Tubular
  3. Brunner’s gland adenomas
278
Q

which organism most commonly causes infected aortic aneurysms?

A

salmonella and staph aureus

279
Q

what is the most common cause for large bowel obstruction in the US?

A

colorectal cancer

280
Q

after adhesions, 2nd most common cause of SBO?

A

malignancy

281
Q

whats the most common cancer cause of chylous ascites?

A

lymphoma

282
Q

buzzword: apthous ulcer, IBD

A

crohns

283
Q

buzzword: distorted vascular pattern, IBD

A

ulcerative colitis

284
Q

what is amaurosis fugax?

A

due to an isolated embolism to the retinal or ophthalmic artery (first branch off internal carotid aa) causing transient monocular blindness

285
Q

ABI for claudication?

A

0.7

286
Q

what is the main blood supply to the rectosigmoid anastomosis in prolapse surgery?

A

superior rectal artery

287
Q

what is a type IV endoleak?

A

transient trans-graft extravasation resulting from porosity of the graft

288
Q

what two deficiencies cause microcytic anemia?

A

iron and Vitamin B6

289
Q

what vitamin deficiency causes a waddling gate?

A

vit D deficiency

290
Q

what vitamin deficiency is associated with hemolytic anemia?

A

vitamin E

291
Q

what deficiency causes megaloblastic anemia?

A

folate

292
Q

Five grades of pancreatic injury?

A

Grade I: small hematoma without duct injury
Grade II: large hematoma wo duct injury
Grade III: a distal laceration w duct injury
Grade IV: proximal transection
Grade V: massive disruption

293
Q

what is a nissen fundoplication?

A

complete 360 degre fundoplication

294
Q

what is a belsey mark IV fundoplication?

A

left thoracotomy -> proximal stomach is delivered through the esophageal hiatus then a 270 degree plication of the fundus and buttressed by the crura

295
Q

what is an anterior dor fundoplication?

A

a 180-200 degree fundoplication

296
Q

what is a watson fundoplication?

A

fixation of esophagus in an intra-abdominal location with plication of fundus along the left anterior esophagus

297
Q

what is the hill repair?

A

plication of the lesser curvature around the right side of the esophagus with an esophagogastropexy to the median arcuate ligament

298
Q

what is a posterior toupet fundoplication?

A

fundus is pulled posterior to the esophagus with suture of the leading edge of the wrapped fundus to the right anterolateral aspect of the esophagus

299
Q

treatment of stenosis of lap sleeve gastrectomy?

A

endoscopic balloon dilation

300
Q

child with downs syndrome and projectile vomiting with double bubble sign on KUB

A

duodenal atresia

301
Q

order in which you should explore a packed abdomen? trauma ex lap

A

inframesocolic, supramesocolic, retroperitoneal, lesser sac

302
Q

what is hemophilia A?

A

Factor VII deficiency

303
Q

what is pellagra?

A

diarrhea, dermatitis, dementia

Niacin deficiency! (vit B3)

304
Q

What are the Milan criteria for txp of pt w HCC?

A
  1. Single tumor <5cm
  2. Up to 3 tumors all <3cm
  3. No LVI/mets/nodes
305
Q

management of dysplasia (any kind) found on colonoscopy of pt w UC?

A

total proctocolectomy with IPAA

306
Q

most common cause of acute pancreatitis in the US?

A

gallstones

307
Q

poor prognostic factors for parathyroid cancer?

A
  1. Male gender
  2. Older age at diagnosis
  3. presence of metastatic disease
308
Q

order of restoration of bowel motility

A

small intestine, stomach, colon

309
Q

what is the only effective systemic medical therapy for HCC?

A

sorafenib: multikinase inhibitor (VEG-F, c-kit, PDGFreceptor)

310
Q

indication for TIPS procedure?

A

transjugular intrahepatic portocaval shunt

- perform when pt requires >2-3 paracentesis per month despite maximal medical therapy

311
Q

innervation of thoracodorsal nerve

A

latissimus dorsi

312
Q

innvervation of long thoracic nerve?

A

serratus anterior

313
Q

growth of an axon and cells that help it grow

A

1-2mm/day, schwann cells play significant role in axon regeneration

314
Q

calculating fluid resuscitation in a burned child and what fluid

A

cannot use parkland formula for kids <20kg, thus use TBSA Shriners-galveston formula (5L/m2 BSA burned + 2L/m2 BSA total)
- smaller glycogen stores so use 5% dextrose

315
Q

MOA of omeprazole?

A

inhibition H+/K+ ATPase

316
Q

rule of 9’s: adults vs children

A

Adult: each arm = 9, each leg = 18, anterior trunk = 18, posterior trunk = 18, head = 9
child: all the same but each leg = 14, head = 18

317
Q

MOA desmopressin

A

ddAVP = analogue of vasopessin, causes factor VIII and vWF to be released from the vascular endothelium

318
Q

what is the classification system used for esophagitis? (A-D)

A

Modified Los Angeles Classification
A: mucosal break <5mm
B: mucosal break >5mm but doesnt extend between two mucosal folds
C: mucosal break that is continuous but <75% circumference
D: mucosal break(s) that involves at least 75% circumference

319
Q

what sites does melanoma most likely like to metastasize to?

A
  1. Small intestine
  2. Colon
  3. Stomach
320
Q

What type of bacteria is clostridium difficile?

A

Gram positie bacillus

321
Q

management of rectal cancer T2 and above

A

neoadjuvant chemo XRT

322
Q

margins for basal cell carcinoma

A

0.5cm

323
Q

standard reconstruction after distal gastrectomy

A

Billroth I

324
Q

which procedure for distract gastrectomy has the highest incidence of bile reflux gastritis?

A

billoth II

325
Q

whats the difference between a billroth I and II?

A

Billroth I: has a gastroduodenostomy

Billroth II: has a gastrojejunostomy

326
Q

treatment of significant bile reflux gastritis after a billroth II?

A

conversion to roux-en-y gastrojejunostomy

327
Q

types of gastric ulcrs

A

I: lessr curvatue
II: combination of stomach and duodenal
III: prepyloric
IV: near GE junction

328
Q

indications for gastrectomy for gastric ulcers?

A

type II and III that have failed 12 weeks medical management

329
Q

which types of gastric ulcers are associated with acid hypersecretion?

A

type II and type III (thus a vagotomy is performed in these patients)

330
Q

how do you perform a heller myotomy?

A

divide all the circular muscle layers by extending the myotomy 2cm below GE junction and 5cm proximally

331
Q

what is the strasberg classification system?

A

classifies bile duct injuries:
A: leakage from cystic stump or duct of luschka
B: ligation of aberrant right hepatic duct
C: transection of aberrant right hepatic duct
D: lateral injury to a major duct
E: complex, bad, vascular can be involved

332
Q

what is the Ladd procedure? steps of the procedure?

A

for intestinal malrotation, Ladds bands attach cecum to abdominal wall compressing duodenum

1st: relief of midgust volvulus with counterclockwise rotation
2. Complete division of abnormal peritoneal attachments (Ladds bands)
3. Mobilize duodenum
4. Appendectomy

333
Q

function of protein C

A

it inhibits factors V and VIII

334
Q

diagnostic test for cushing syndrome

A

low dose dexamethasone suppression test, give 1mg at 11pm and check 8am levels- it should suppress cortisol to <5ug/dl

335
Q

how do you calculate the prevalence of disease?

A

true positives plus false negatives divided by total number of tests

336
Q

primary treatment for mucosa-associated lymphoid tissue?

A

associated w H. pylori so eradicate that!

337
Q

celiacs disease that persists despite gluten free diet

A

think T cell lymphoma of the intestines

338
Q

what do cytotoxic t-lymphocytes bind to?

A

CD8+/MHC class I cells

339
Q

what medications can cause gynecomastia in men?

A

ACE inhibitors

amiodarone

340
Q

IBD: rectal sparing

A

crohns

341
Q

whats the most common complication of traumatic liver injury?

A

biliary fistula

342
Q

where should the medial incision be made in a 2-incision fasciotomy?

A

one fingerbreadth posterior to the tibia

343
Q

where should the lateral incision be made in a 2-incision fasciotomy?

A

3cm fingerbreadths lateral to the tibia

344
Q

which of the extra-intestinal manifestations of Crohn’s disease will most likely resolve with successful medical or surgical treatment? (4)

A
  1. erythema nodosum
  2. Peripheral Arthritis
  3. Aphthous ulcers
  4. Episcleritis
345
Q

which of the extra-intestinal manifestations of Crohn’s disease will NOT resolve with successful medical or surgical treatment? (4)

A
  1. Ankylosing spondylitis
  2. Pyoderma gangrenosum
  3. Uveitis
  4. PSC
346
Q

what is the best indicator of preoperative nutritional status?

A

albumin

347
Q

half life of alumin versus prealbumin

A

albumin: 21 days

pre-albumin: 2 days

348
Q

what is the best indicator of POSToperative nutritional status?

A

pre-albumin

349
Q

where do gastric carcinoids most commonly occur?

A

small bowel- ileum

350
Q

what type of enema do u use to reduce intussusception in a child?

A

air enema! barium causes too many problems if pef occurs

351
Q

where does a TRAM flap get its vascular pedicle?

A

inferior epigastric vessels

352
Q

where does a latissimus dorsi flap get its vascular pedicle?

A

thoracodorsal vessels

353
Q

what is the maximum size vessel you can seal w bipolar?

A

7mm

354
Q

what is the best test to assess for the presence of a rectovaginal fistula?

A

mathylene blue tampon test

355
Q

what is a psoas hitch and when is it performed?

A

distal ureter injury and remaining ureter doesn’t reach the bladder, bladder is pulled up and secured to psoas muscle

356
Q

what is a BOARI flap and when is it used?

A

the peritoneum of the bladder is used to create a flap that extends to the injured ureter, used in distal long segment ureteral injuries

357
Q

What will shift the oxygen dissociation curve to the left?

A 
HOLDING ONTO O2
Hypothermia 
alkalosis
hypocapnea
Decreased 2,3 DPG
358
Q

what will shift the oxygen dissociation curve to the right?

A 
OFFLOADING O2
fever
acidosis
hypoxia/hypercapnea
increased 2,3 DPG
359
Q

what hormone can be used in the treatment of hypercalcemic crisis?

A

calcitonin: inhibits osteoclast bone resorption and thus decreases serum Ca levels

360
Q

how do you diagnose biliary dyskinesia?

A

HIDA showing gallbladder EF <20% at 20 minutes

361
Q

what is function of CCK?

A
  1. GB contraction
  2. Relaxation of sphincter of oddi
  3. pancreatic enzyme secretion
  4. decreasing gastric emptying
362
Q

what 2 hormones inhibit CCK?

A
  1. Somatostatin

2. Pancreatic Polypeptide

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