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BOARD REVIEW > SURGERY > Flashcards

SURGERY Flashcards

1
Q

Phases of wound healing

A

Phase I - Hemostasos and Inflammation
Phase II - Proliferation
Phase III - Maturation and Remodeling

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2
Q

First infiltrating cells to enter wound site

A

Polymorphonucleic acid/ neutrophils
“NAUNA”

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3
Q

2nd population of inflammatory cells that invades the wound
Remain present until the wound healing is complete

A

Macrophage

“Matagal mawala”
“Maestro”

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4
Q

Bridge between phase I and II
Peaks about 1 week lost injury

A

T lymphocyte
“Tulay”

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5
Q

Arrival of fibroblast and endothelial cells

A

Proliferation phase

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6
Q

Last cells to infiltrate the healing wound

A

Fobroblast and endothelial cells

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7
Q

Stronges chemotactic factor for fibroblasts matrix synthesis

A

PDGF
Platelet derived growth factor

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8
Q

Matrix component

A

Type III collagen (early matrix)
Proteoglycan
Type I collage (final matrix)

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9
Q

Most abundant protein in the body

A

Collagen

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10
Q

Clean wound

A

Primary intention
Suture the wound

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11
Q

Dirty wound

A

Let the tissue degranulate itself
No suture

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12
Q

Elective colon resection

A

Clean contaminated
Bowel prep
Enema
Clean bowel

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13
Q

Major cell responsible for contraction

A

Myofibroblasts

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14
Q

Can stimulate epithelialization of wound that was affected by steroid delayed healing

A

Vit A

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15
Q

Dilute sodium hypochlorite used in contaminated wounds

A

Dakin’s solution

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16
Q

Amino acid that is most active in terms of wound fibroplasia

A

Arginine

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17
Q

Vitamin deficiency leads t failure of collagen synthesis and cross linking

A

Vit C

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18
Q

Epithelialization of a sutured wound

A

24 to 48 hrs

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19
Q

Stays within confines of original wound

A

Hypertrophic scar

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20
Q

Keloid

A

extends beyond confines of original wound

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21
Q

Malignant transformation of chronic wound

A

Marjolin ulcers

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22
Q

Most common trauma ressucitation fluid

A

Plain LR

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23
Q

Treatment of hyperkalemia

A

Calcium gluconate
Bicarbonate
Insulin
Glucose
Kayexalate

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24
Q

High peaked T waves
Widened QRS
Ventricular fibrillation

A

Hyperkalemia

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25
Q

U wave
T wave flattening

A

Hypokalemia

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26
Q

Nyhus type IIIA

A

Direct hernia

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27
Q

Most common groin hernia on bothe men and women

A

Indirect ingunal hernia

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28
Q

Femoral hernia is common in what population

A

Female

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29
Q

Nyhus Type IIIC

A

Femoral hernia

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30
Q

Hesselbach’s triangle

A

Superior : Inferioir Epigastric
Inferior: Inguinal Ligament
Medial: Lateral edge of rectus sheath

“Hassle = IE IL LR (E L R) “

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31
Q

Hernia where it protrudes MEDIAL to the inferior epigastric vessels, within Hesselbach’s triangle

A

Direct hernia

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32
Q

Hernia where it protrudes LATERAL to the inferior epigastric vessels through the deep inguinal ring, lateral to Hesselbach’s triangle

A

Indirect hernia

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33
Q

Hernia protrudes BELOW inguinal canal between the femoral vein and lymphatic channels

A

Femoral hernias

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34
Q

Space between peritoneum and the posterior lamina of the transversalis fascia
Contains peritoneal fat

A

Space of Bogros

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35
Q

Most media area of the space of bogros lying superior to the bladder

A

Retzius space

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36
Q

Spacw between anterior and poaterior laminar of the transversalis fascia
Contains Inferior Epigastric Vessels

A

Vascular space

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37
Q

Triangle of Pain borders

A

IlioPubic tract
Gonadal vessels

“PIG”

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38
Q

Triangle of Doom borders

A

Ductus deferens - medial
Gonadal vessels

Doom = “DuGo”

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39
Q

Triangle of Doom contents

A

Deep circumflex iliac vein
External iliac vessels
Femoral nerve
Genital branch of genitofemoral nerve

“Content: cDEFG”

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40
Q

Circle of Death

A

Common Iliac
Internal Iliac
External Iliac
Obturator
Inferior Epigastric

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41
Q

Tissue repair high tension and high recurrence rates

Triple layer repair: Internal oblique, transversus abdominis and transversalis fascia foxed to the inguinal ligament and pubic periosteum in simple interrupted sutures

A

Bassini repair

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42
Q

Moat commonly used tissue repair

Routine division of the genital branch of the genitofemoral nerve

Less recurrence, less tension

A

Shouldice repair

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43
Q

Tissue repair in both inguinal and femoral hernia

Fixes the superior flap to the COOPER’S LIGAMENT continuing it laterally to occlude the femoral ring

Relaxing incision on the anterior rectus sheath

A

McVay repair

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44
Q

Mesh free repair which utilizes the external oblique aponeurosis

A

Desarda repair

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45
Q

Most commonly performed ingubal hernia repair

Tension free and buttresses the inguinal floor with prosthetic mesh

A

Lichtenstein technique

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46
Q

Laparoscopic approach for bilatwral hernia

Higher risk of intraabdominal injuries

A

Transabdominal Preperitoneal Repair (TAP)

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47
Q

Peritoneum is not incised but instead a mesh is placed directly over the defect and fixed in place by tacks

Used if TEP and TAP unfeasible

A

Intraperitoneal Onlay Mesh Repair (IPOM)

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48
Q

1-2 cm midline neck mass that moves upward with protrusion of the tongue

8th week persistence

A

Thyroglossal duct cyst

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49
Q

Recurrent Laryngeal nerve innervates ALL laryngeal muscles EXCEPT

A

Cricothyroid

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50
Q

RLN that has more oblique course
Left or right?

A

Right
= harder to find

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51
Q

Nerve that supplies the CRICOTHYROID

A

Superior Laryngeal Nerve

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52
Q

Injury yo the external branch of Superior Laryngeal Nerve will cause…

A

Difficulty hitting high notes and voice fatigue

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53
Q

Marker for Medullary thyroid cancer

A

Serum calcitonin

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54
Q

Positive prehn sign means?

A

+ prehn sign = relief from pain when lifting the testicle

= epididymitis

(-) prehn sign = no relief = testicular torsion

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55
Q

Most common type of lipid profile associated with pancreatitis

A

Type 5 (increased triglycerides)

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56
Q

Antibiotics given to patients with severe pancreatitis

A

imipinem

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57
Q

Most common variants in origin of hepatic arteries

A

right hepatic - off SMA, 20%
left hepatic - off LEFT GASTRIC, 10%

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58
Q

Structures in portal triad

A

Portal Vein - Posterior
CBD - on the Right anteriorly
Hepatic Artery - on Left anteriorly

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59
Q

bacteria most common agents of biliary sepsis

A

E. coli and Klebsiella

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60
Q

triad of hematobilia

A

GI bleed
Jaundice
RUQ pain

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61
Q

CHarcot’s triad —- CHolangitis

A

Fever (w/ chills)
Jaundice
RUQ tenderness (biliary colic)

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62
Q

Reynod’s pentad

A

Fever
Jaundice
RUQ tenderness
HYPO tension
Mental status change

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63
Q

Most common cause of biliary stricture

A

Iatrogenic injury (lap chole)

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64
Q

most common cause of cholangitis after choledocoduodenostomy or choledochojejunostomy

A

anastomotic stricture

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65
Q

a large gallstone in the NECK of the gallbladder, compressing the COMMON BILE DUCT and inducing biliary obstruction

A

Mirizi syndrome

Type 1 - obstruction only
Type 2 - cholecystic-biliary fistula

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66
Q

5 types of choledochal cysts

A

Type 1 (most common) - Fusiform extrahepatic (tx - resection and hepaticojejunostomy)
Type 2 - diverticulum of CBD
Type 3 - periampullary
Type 4 - intra and extrahepatic
Type 5 - intrahepatic

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67
Q

Rule of 10 for Insulinomas

A

10% slitary
10% malignant
10% associated with MEN
10% ectopic

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68
Q

Risk factors for Budd-Chiari syndrome (hepatic vein thrombosis)

A

Hypercoaguable conditions (pregnancy, factor 5 leiden mutation, hepatitis, liver abscess, polycythemia, malignancy and other inheritable conditions)

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69
Q

most common presentation of Budd-chiari syndrome

A

Hypercoaguable patient who presents with ascites and abdominal distention

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70
Q

treatment option of Budd-chiari syndrome

A

Vena cava present and hepatic function salvageable —> portosystemic shunt
Partial hepatic venous thrombosis present —> thrombolysis and stenting
Fulminant hepatic failure —> transplant

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71
Q

Unknown etiology with multiple dilatations and strictures of intra- and extrahepatic biliary ducts (beading)

A

Primary sclerosing cholangitis

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72
Q

most common site of obstruction in gallstone ileus

A

Terminal ileum

Classic presentation:
- Air in biliary tract
- SBO

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73
Q

most common cause of amoebic liver abscess?
tx?

A

Entamoeba histolytica
Metronidazole

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74
Q

Normal pancreatic anatomy in oatients with pancreatic divisum

A

NL - Santorini = small; Wirsung = major
Divisum - Santorini = major duct

Divisum occurs in 5% pop and is an embryonic failure of fusion of ducts
–prone to pancreatitis

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75
Q

gene mutated in 90% of pancreatic cancer patients

A

K-Ras

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76
Q

Most common islet cell tumor

A

Insulinoma

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77
Q

Surgical tx of Insulinoma

A

Enucleation

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78
Q

Deficiency of these coagulation inhibitors in patients with liver disease may lead to thrombotic states

A

antithrombin III
Protein C
Protein S

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79
Q

true or false
Regional anesthesia is contraindicated with patients with coagulopathy

A

True

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80
Q

Drugs effective if spasm of the sphinctr of Oddi is suspected

A

Atropine
Glucagon
Nalaxone
Nitroglygerin

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81
Q

Gallstone associated with cirrhosis and hemolysis

A

Black-pigment stones (bilirubin)

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82
Q

how to confirm diagnosis of amebic abscess?

A

By indirect hemagglutination

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83
Q

Pathological features of hepatocellular carcinoma (HCC) are associated improved survival

A

tumors exhibiting the FIBROLAMELLAR variant, ENCAPSULATED tumor, and PEDUNCULATED tumors

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84
Q

an operation for bleeding esophageal varices in which division of the esophageal varices is accomplished by TRANSECTION of ESOPHAGUS and REANASTOMOSIS, usually with an EEA stapler

A

Sigura procedure

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85
Q

proper treatment for bleeding gastric varices without esophageal varices

A

splenectomy for splenic vein thrombosis

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86
Q

most common cause of portal hypertension in children

A

portal vein thrombosis

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87
Q

what pressure defines portal hypertension

A

12mmHg

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88
Q

Substances thought to be responsible for the hyperdynamic circulation seen in patients with cirrhosis and portal hypertension

A

Prostaglandins
Glucagon
Nitric oxide
TNF

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89
Q
A
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90
Q

Laboratory findings in a patient with Idiopathic Thrombocytopenia Purpura (ITP)

A

Platelet count less than 50,000/mm³
Prolonged bleeding time
Normal clotting time

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91
Q

Treatment for ITP

A

Initial 6 weeks to 6 months trial of steroids
If there is no response to steroid therapy, splenectomy is indicated

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92
Q

Mechanism of portal hypertension caused by schistosomiasis

A

Presinusoidal obstruction

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93
Q

30yo female
Acute onset fever and purpura
Anemia
Thrombocytopenia
Leukocytosis
Elevated BUN and creatinine
Dx?

A

Thrombotic Thrombocytopenic Purpura (TTP)

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94
Q

Characteristic blood smear in postsplenectomy patient

A

Howell-Jolly bodies
Siderocytes
Leukocytosis
Increased platelet count

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95
Q

Most common cause of spontaneous splenic rupture

A

Complications of malaria and mononucleosis

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96
Q

Appropriate management for patients with portal vein injury that cannot be repaired

A

Ligation of the portal vein

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97
Q

Most common cause of secondary hypersplenism

A

Hepatic disease or extrahepatic portal vein obstruction

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98
Q

Clinical manifestation of pancreatic exocrine insufficiency

A

Steatorrhea and malabsorption

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99
Q

Clinical course of sclerosing cholangitis

A

Chronic, relapsing disease associated with jaundice, pruritis, pain and fatigue

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100
Q

Flank ecchymosis
Represents dissection of blood from the retroperitoneum near the pancreas in patients with hemorrhagic pancreatitis

A

Gray Turner’s syndrome/sign

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101
Q

Serum amylase of patient with acute pancreatitis

A

2 to 5 times normal

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102
Q

Most common finding on plain abdominal xray in patient with acute pancreatitis

A

Dilatation of an isolated loop of intestine adjacent to the pancreas (sentinel loop)

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103
Q

Principal symptom in majority of patients with chronic pancreatitis

A

Abdominal pain (epigastrium), cramping, boring or aching

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104
Q

Most common complication of chronic pancreatitis

A

Pseudocyst, DM and malnutrition

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105
Q

Most common islet cell tumor in MEN-1

A

Gastrinoma

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106
Q

Most common location of gastrinoma

A

Gastrinoma triangle
- cystic/CBD junction
- pancreas neck
- third portion duodenum

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107
Q

Medical conditions associated with somatostinoma

A

Gallstones
Steatorrhea
Pancreatitis
Diabetes

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108
Q

Syndrome associated with Vasoactive Intestinal Polypeptide (VIP)oma

A

WDHA syndrome
Watery Diarrhea
HypoKalemia
Achlorhydia

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109
Q

Lateral pancreaticojejunostomy

A

Puestow procedure

Perfor thus procedure if >7mm diameter of main pancreatic duct

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110
Q

What is meant by modified whipple?

A

Preservation of the stomach and pylorus

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111
Q

Most common benign neoplasm of the exocrine pancreas

A

Serous (microcystic) cystadenomas

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112
Q

If the patient has a serum gastrin level of 200 to 500 pg/mL, what test must be done to confirm the diagnosis of gastrinoma?

A

Secretin provocative test

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113
Q

DOC for treatment of gastrinoma

A

Omeprazole

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114
Q

Cause of most cases of WDHA

A

Islet Cell Tumor of the pancreas that produces VIP

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115
Q

Conditions associated with Annular pancreas

A

Down’s syndrome
Duodenal atresia
Peptic ulcer

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116
Q

Most common type of biliary enteric fistula

A

Cholecystoduodenal

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117
Q

Most common clinical manifestation of decompensation in a cirrhotic patient?

A

Ascites

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118
Q

Most common benign hepatic tumor

A

Cavernous hemangioma

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119
Q

(+) kupffer cells
What benign hepatic lesion?

A

FNH

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120
Q

Multiple thin adhesions (“violin string adhesion”) seen in the RUQ to the surface of liver and surrounding fundus of the gallbladder

A

Fitz-Hugh-curtis syndrome
-intraabdominal dissemination of pelvic inflammatory disease (PID)

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121
Q

Name of cholangiocarcinoma that presents at the confluence of the right and left hepatic ducts

A

Klatskin tumor

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122
Q

Pathognomonic finding for chronic pancreatitis on KUB

A

Pancreatic calcifications

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123
Q

Most specific and sensitive test for diagnosis of chronic pancreatitis

A

ERCP

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124
Q

Endoscopic finding hallmark of Zollinger-Ellsion syndrome

A

Peptic ulcerations in an unusual site, including postbulbar and JEJUNAL ulcerations

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125
Q

Where are primary bile salts converted to secondary bile salts?

A

Small intestine

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126
Q

How is caudate lobe different from the other segments of the liver, with respect to its vascular supply?

A

Receives blood from L and R hepatic arteries and portal vein. Most venous blood drains directly into the vena cava

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127
Q

Risk factors of HCC

A

Aflatoxins
Low protein intake
Hepatitis B and C
Cirrhosis

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128
Q

What organisms produce hydatid cysts of the liver

A

Echinococcus granulosus and echinococcus multilocularis

Tx: enucleation and avoid spilling the cyst as it may cause anaphylaxis

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129
Q

Drug that reduces the risk of rebleeding after a first bleed by decreasing the portal pressure of patients with bleeding esophageal varices

A

Propranolol

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130
Q

Arterial supply shared by head of pancreas and 2nd and 3rd portions of the duodenum

A

Inferior pancreaticoduodenal artery, from superior mesenteric artery, collaterizes with superior pancreaticoduodenal artery, arising from gastroduodenal artery

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131
Q

The only pancreatic enzyme secreted in active form

A

Amylase

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132
Q

Vessels contained within the GastroSplenic ligament

A

ShortGastrics

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133
Q

Primary pathophysio in acalculous cholecystitis

A

Gallbladder stasis

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134
Q

Anemia
Reticulocytosis
Jaundice
Splenomegaly

A

Hereditary spherocytosis

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135
Q

Splenomagaly
Anemia
Neutropenia
Thrombocytopenia
Arthritis (rheumatoid)

A

Felty syndrome
“SANTA”

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136
Q

Indication of splenectomy in patient with Felty syndrome

A

Recurrent infections with neutropenia
Patient requiring transfusion for anemia
Profound thrombocytopenia
Intractable leg ulcers

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137
Q

Main chemical component of pigment gallstone

A

Calcium bilirubinate

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138
Q

IV drug user
Fever with chills
Splenomegaly
LUQ abdominal tenderness
Dx?

A

Splenic abscess
Tx: splenectomy

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139
Q

Principal anions in pancreatic juice

A

Bicarbonate
Chloride

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140
Q

Structure at the posterior of portal vein and superior mesenteric vessels

A

Uncinate process of pancreas

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141
Q

Cells synthesize somatostatin

A

Delta cells

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142
Q

Abnormal rotation and fusion of Ventral pancreatic primordium

A

Annular pancreas

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143
Q

Significance of the colon cutoff sign

A

Caused by inflammation of pancreas, which induces spasm in the adjacent colon

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144
Q

Region of the pancreas where most pseudocyst occur

A

Body of pancreas

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145
Q

Classic diagnostic (Whipple’s) triad for insulinoma

A

Hypoglycemic symptoms produced by fasting glucose less than 50mg/dL during symptomatic episodes and relief of symptoms with IV administration of glucose

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146
Q

Distended and palpable gallbladder in a jaundiced patient

Suggests malignant obstruction

A

Courvoisier’s sign

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147
Q

Organs included in Whipple procedure

A

Distal stomach
Gallbladder
Common bile duct
Head of pancreas
Duodenum
Proximal jejunum
Regional lymphatics

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148
Q

Etiology of Zollinger ellison syndrome

A

Gastric acid hypersecretion caused by excessive gastrin production

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149
Q

How many molecules of ATP does glycolysis generate for each molecule of glucose?

A

37, with one molecule being utilized for storage

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150
Q

Landmarks that demarcates right hepatic lobe from left hepatic lobe

A

Gallbladder fossa and IVC

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151
Q

Manomerty : Failure of Lower esophageal sphincter (LES) to relax completely, with swallowing associated with an absence of organized propulsive peristalsis, and nonpropulsive simultaneous contractions (tertiary waves) on manometry

A

Achalasia

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152
Q

Most common complain of patient with duodenal ulcer

A

Epigastric pain

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153
Q

Esophagogastroduodenoscopy (EGD) : bird beak esophagus is the classic UGI finding. The gastroesophageal (GE) junction should not appear strictured unless its end stage case

A

Achalasia

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154
Q

What does parietal cell secrete?

A

HCL and Intrinsic factor

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155
Q

what does intrinsic factor assist in?

A

binds to B12 and allows B12 absorption in Terminal Ileum

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156
Q

2 layers plicating sutures placed between the gastric fundus and the lower esophagus with subsequent creation of a 280-deg anterior gastric wrap and posterior approximation of the crura

A

Belsey procedure

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157
Q

best test to dx GERD

A

24 hr pH probe

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158
Q

Chief cells produce?

A

Pepsinogen
- initiates gastric proteolysis

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159
Q

Peptide activates the digestive cascade

A

Enterokinase - acts on Trypsinogen to Trypsin

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160
Q

Tx for achalasia

A
  1. Endoscopic dilation or botulinum injection
  2. Esophagomyotomy - HELLER MYOTOMY
  3. Total esophagectomy
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161
Q

presence of 2 to 3 cm of columnar intestinal epithelium along the esophageal mucosa

A

Barrett’s esophagus
= intestinal metaplasia

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162
Q

highly selective vagotomy is

A

division of individual branches of the nerve of Latarjet, preserving the crow’s foot

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163
Q

classic metabolic abnormality associated with Gastric Outlet Obstruction

A

HypOchloremic, hypOkalemic metabOlic acidOsis

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164
Q

most common type of gastric polyp

A

Hyperplastic polyps

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165
Q

a proximal branch of Posterior vagus nerve which can be missed during vagotomy and can lead to persistent gastric secretion

A

criminal nerve of Grassi

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166
Q

3 main peptides that stimulate the parietal cell

A

Acetylcholine
Histamine
Gastrin
——which through calcium, activate protein kinase C, which increases HCl secretion

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167
Q

G cell produce?

A

Gastrin
Located at the antrum of stomach.
Stimulated by amino acids and acetylcystine
Inhibited by acid

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168
Q

cell hypeplasia increase in gastrin levels associated with?

A

Enterochromaffin hyperplasia (precarcinoid lesion)

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169
Q

Test for gastrinoma

A

Secretin stimulation test

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170
Q

MOA of omeprzole

A

blocking of H/K ATPase of parietal cell with a secondary decrease in acid production

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171
Q

a dense annular band in the submucosa at squamocolumnar junction

A

Schatzki’s ring

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172
Q

Most potent stimulant for gastric acid secretion

A

high protein meal

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173
Q

80yo man
dysphagia
gurgling in neck when swallowing

A

Zenker’s diverticulum

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174
Q

Dx test for Zenkers diverticulum

A

Barium swallow

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175
Q

Function of somatostatin

A

Pan-GI inhibition
Inhibits Gastrin,
Insulin,
Secretin,
Ach
Pancreatic and biliary output

Release is stimulated by ACID in DUOdenum

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176
Q

Peptide YY

A

released in Terminal Ileum and acts to INHibit acid secretion and GI motility

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177
Q

Most common malignant neoplasm of esophagus

A

Adenocarcinoma

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178
Q

Tx for Barrett’s metplasia

A

Nissen fundoplication

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179
Q

How does erythromycin stimulates GI tract

A

acts on motilin receptorand is prokinetic
Motilin is the key stimulatory hormone of MMC

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180
Q

Where does most water absorption occur?

A

Jejunum

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181
Q

Recommended therapy for PUD in pregnancy

A

Sucralfate - minimal systemic absorption and acceptable healing rates of 80% in 6 weeks

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182
Q

longitudinal incision of pylorus that is closed transversely

A

Heineke-Mikulize procedure

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183
Q

How does GB concentrate bile?

A

Active reabsorption of Na and Cl with water absorption via osmosis. The bile pool is 5g and is recirculated every 4 hours and we lose 0.5g daily

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184
Q

Primary bile acids

A

cholic and chenodeoxycholic acid

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185
Q

Secondary bile acids

A

deoxycholic acid and lithocholic acid

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186
Q

Strongest cell layer in the esophagus

A

Mucosa
(NO SEROSA IN ESOPHAGUS)

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187
Q

type of hiatal hernia always managed surgically

A

paraesophageal

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188
Q

Tx for Zenker’s diverticulum

A

Myotomy and Diverticulectomy

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189
Q

most common location for ectopic pancreas

A

gastric antrum or duodenum

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190
Q

most common malignant tumor of duodenum

A

Adenocarcinoma

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191
Q

Atrophic gastritis
Adult onset celiac sprue
Chronic pancreatitis

A

GI manifestation of Sjogren’s syndrome

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192
Q

initial procedure for patient with Zollinger-Ellison ayndrome and hypertparathyroidism

A

Parathyroidectomy

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193
Q

Normal components of bile

A

Bile salts - 80%
Lecithin - 15%
Cholesterol - 5% (increase cholesterol concentration form stones)

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194
Q

Frequent simultaneous contractions associated with normal LES function and normal peristaltic contractions

A

manometric criteria for Diffuse Esophageal Spasm (DES)

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195
Q

treatment for intractable GERD in patient with poor esophageal motility

A

Posterior partial (Toupet) fundoplication

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196
Q

Tx for DES

A
  1. Nitrate or calcium channel blocker therapy
  2. extended esophageal myotomy
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197
Q

Factors make GI fistulas less likely to heal with non operative therapy

A

Foreign body
Radiation
IBD or Infection
Epithelization
Neoplasm
Distal Obstruction
Sepsis

“FRIENDS”

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198
Q

Best surgical approach for resection of a bulky esophageal carcinoma 25cm from incisors

A

Ivor-Lewis approach (combined laparotomy, right thoracotomy and cervical approach)

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199
Q

Most common location of stomach ulcer

A

Lesser curvature, near incisura angularis (type 1)

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200
Q

Cobblestoning of mucosa on EGC with granulomas on biopsy

A

UGI Crohn’s disease
(coexisting lower ileal GI Crohns is almost universal)

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201
Q

Most common sarcoma of stomach

A

Leiomyosarcoma

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202
Q

Most common site of esophageal perforation in Boerhaave’s syndrome

A

Left Posterolateral esophagus, 3-5cm above GE junction

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203
Q

Submucosal defect overlying an artery in the muscularis

Most common in lesser curvature of stomach

A

Diulafoy’s lesion

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204
Q

Decrease in number of ganglion cells in Auerbach plexus

A

Chaga’s disease or Achalasia

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205
Q
A
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206
Q

Structures supplied by superior mesenteric artery

A

Small bowel from liganent of treitz to cecum
Ascending colon
Trabsverse colon

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207
Q

Gut hormone released from small bowel mucosa after contact with tryptophan and/or fatty acids and results in secretion of enzymes by pancreatic acinar cells

A

Cholecystokinin (CCK)

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208
Q

Where are bile salts reabsorbed?

A

Ileum

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209
Q

Dense retrosacral fascia that covers the sacrum and overlying vessels and nerves

A

Waldeyer’s fascia

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210
Q

Energy source for active sodium transport in the colon

A

Short chain fatty acids

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211
Q

Strongest component of the small bowel wall

A

Submucosa

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212
Q

Hormones inhibit colonic motility

A

Glucagon and somatostatin

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213
Q

Most abundant organism in colon

A

Bacteroides and E. Coli

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214
Q

Region of the colon where volvulus most frequently occur

A

Sigmoid colon

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215
Q

Large dilated loop of colon oriented to the RUQ (“Tire sign”)
Bird beak tapering of the distal sigmoid colon

A

Sigmoid volvulus

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216
Q

Colonic diverticula most commonly occur in

A

Sigmoid colon

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217
Q

LLQ abdominal pain may radiate to suprapubic area, left groin or back and alteration in bowel habits (usually constipation)

A

Symptoms of acute diverticulitis

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218
Q

Xray- large, air-filled right colon
83 yo
Severe abdominal distention w/out significant pain or tenderness
Dx?

A

Ogilvie syndrome

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219
Q

Tx for colonic pseudo-obstruction (Ogilvie syndrome)

A

Colonoscopic decompression and Neostigmine (cholinesterase inhibitor) to increase parasympathetic function

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220
Q

Test of choice to confirm diverticulitis

A

CT scan

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221
Q

MC complication of diverticulitis

A

Fistula and abscess formation

222
Q

Most common cause of massive colonic hemorrhage

A

Diverticulosis and Angiodysplasia

223
Q

MC site of Angiodysplasia

A

Cecum and right colon

224
Q

4 primary small bowel cancer and their common site

A
  1. Adenocarcinoma - Proximal
  2. Carcinoid tumor - Distal (Ileum and SMA)
  3. Lymphoma - Throughout tract
  4. Gastrointestinal Stromal tumor (GIST)/ Sarcoma - throughout tract

Tx for all- sx resection

225
Q

Intolerance of gluten (wheat, barley, rye). Results in diarrhea. Increase risk of future GI malignancy particularly small bowel lulymphoma.

A

Celiac Sprue disease (Gluten enteropathy)

226
Q

Submicosal hemorrhage, edema, and thumb printing of the involved colonic segment

A

Ischemic colitis

227
Q

Demarcation line of internal from external hemorrhoids

A

Dentate line

228
Q

Indications for excisional hemorrhoidectomy

A
  1. Large 3rd or 4th degree hemorrhoids cannot be treated in OPD
  2. Mixed hemorrhoids w/ external endoderm component amenable to resection
  3. Acutely thrombosed or incarcerated w/severe pain and impending gangrene
229
Q

MC location of anal fissures

A

Posterior midline

230
Q

Antibiotics most frequently implicated in the development of pseudomembranous colitis

A

Clindamycin (MC!!)
Ampicillin
Cephalosporins

231
Q

Organism associated with pseudomembranous colitis

A

C. Difficile

232
Q

DOC for C. difficile colitis

A

IV or oral METRONIDAZOLE or oral Vancomycin (metro contraindicated to pregnant)

233
Q

Most common protozoon that infects the colon

A

E. histolytica — cystic form

234
Q

DOC for E. histolytica

A

Metronidazole

235
Q

Tx of choice for CMV colitis

A

Gancyclovir

236
Q

Etiology of Chaga’s disease

A

Trypanosoma cruzi

237
Q

Contents of ischiorectal fossa

A

Inferior rectal vessels and lymphatics

238
Q

Tx of squamous cell CA of anal canal

A

Nigro protocol: chemo + radiation
Recurrence is treated with abdominiperoneal resection

239
Q

Cancers associated with Lynch II (hereditary nonpolyposis colorectal cancer)

A

Stomach
Ovary
Bladder
Colonoscopy should start at 20yo. Also screening for uterine and ovarian cancer

Type 1 has no associated increase risk of other malignancies

240
Q

Genetic mutations in Lynch I and II syndromes associated with

A

DNA mismatch repair gene

241
Q

In tx of fistula in ano, if the anus is transected in transvere fashion, external openings anterior to the incision will connect with an internal opening by a short, direct fistulous tract. Posterior fistilas take a more tortous course

A

Goodsall’s rule

242
Q

Appropriate tx for hidradenitis suppurativa

A

Wide excision, including the indurated overlying skin

243
Q

Most common cause of perianal pruritis in children

A

Emterobius vermicularis (pinworm)

244
Q

Etiology of Lymphogranuloma Vebereum (LGV)

A

Chlamydia trachomatis

245
Q

Multiple, soft lesions that are very PAINFUL and friable

A

ChancROID!!!

246
Q

Treatment of choice for chancroid

A

Sulfonamides

247
Q

Layer of the colon affected by ulcerative colitis

A

Mucosal layer only

248
Q

IBD that has CONTINUOUS distribution in the colon

A

Ulcerative colitis

249
Q

Treatment for acute Crohn’s colitis

A

IV steroids, flagyl and consideration of 6-MP or azathioprine
Sx if with necrosis

250
Q

Hallmark maintenance medication of Crohn’s disease

A

MESALAMINE (Pentasa)
Sulfasalazine
Methotrexate

251
Q

An anti TNF antibody which decreases steroid requirements in acute bouts of Crohn’s disease and aids in closure of perianal fistulas

A

Infliximab

252
Q

Most frequent site of Crohn’s disease

A

IleoCecal region

253
Q

Linear ulceration
Cobblestoning
Asymmetric involvement
Skip lesions
Apthous ulcers
STRICTURES

A

Crohn’s disease

254
Q

Extraintestinal manifestations associated with FAP

A

Epidermoid cyst
Dermoid tumors of abdomen (Gardner’s syndrome)
Osteomas
Brain tumors (gliomas and medulloblastoma)

255
Q

Mutated gene in FAP

A

APC tumor-suppressor gene
Autosomal dominant

256
Q

Mutation of Serotonine Threonin Kinase (STK gene)
Autosomal dominant
Associated with diffuse GI hamartomas

A

Peutz-Jegher’s syndrome

257
Q

Diffuse mucocutaneous pigmentation and multiple GI hamartomas
Increased risk of colon, breast, uterine, small intestinal and ovarian adenocarcinomas

A

Peutz-Jegher’s syndrome

258
Q

MC cause of GI bleed in childhood

A

Meckels diverticulum

259
Q

MC type of adenomatoys colonic polyp

A

Tubular adenoma

260
Q

Conduit of choice during mesenteric revascularization when simultaneous bowel resection is required

A

Saphenous vein

261
Q

Cell in the lumen responsible for ANTIGEN UPTAKE and TRANSPORT to underlying lymphoid nodules

A

M cells

262
Q

Ovarian mass detectable on bimanual pelvic exam which represents a drop metastasis or transcoelomic implantation of the ovary from an intra-abdominal site (stomach)

A

Krukenberg tumor

263
Q

Tumors of mesodermal (interstitial cells of cajal) origin

Bleeding /GI obstruction
HIsto grade predict clinical outcome

A

GISTs

264
Q

Oncogene associated with GISTs

A

C-kit oncogene

265
Q

Adjuvant therapy of choice for GISTs

A

Imitinab (gleevec)
MAB to the Tyrosine Kinase receptor

266
Q

Elevated level of this chemical compound is associated with malignant CARcinoid syndrome

A

5-hydroxyindoleacetic acid (5-HIAA) and
Vanillylmandelic acid (VMA)

267
Q

Crohn’s disease prone to what type of kidney stones

A

Oxalate stones

268
Q

Most frequent location for villous adenomas in the small intestine

A

Duodenum

269
Q

MC source of hematogenously spread malignancy to the small intestine

A

Malignant melanoma

270
Q

65yo female
Mild abdominal distention
Nausea vomiting
KUB- pneumobilia and paucity of air in colon
Dx?

A

Gallstone ileus
- fistulous communication between gallbladder and duodenum.

271
Q

MC location of Kaposi’s sarcoma

A

Duodenum

272
Q

Lymphatics of the lower half of abdominal wall drians in to…

A

Ingunal nodes, then Iliac nodes

273
Q

Most common cause of rectus sheath hematoma

A

Rupture of Epigastric artery or vein secondary to trauma

274
Q

These are aggressive fibromatosis soft-tissue tumors that lack histological features of malignancy yet can be destructive to the abdominal contents when intra-abdominal.

A

Desmoid tumors

275
Q

Blood supply of rectus abdominis muscle

A

Superior and inferior EPIgastric arteries

276
Q

Composition of posterior rectus sheath below linea semicircularis

A

Transversalis fascia

277
Q

Most common solid omental tumor

A

Metastatic carcinoma

278
Q

Hernia found deep to external oblique through the linea semilunaris and inferior to the linea semicircularis.

Difficult to diagnose

A

Spigelian hernia

279
Q

Vessel that runs within the transverse MesoColon

A

Branches of MIddle Colic artery and accompanying vein

280
Q

MC cause of acute occlusion of SMA

A

Emboli (from heart)

281
Q

Most frequent visceral artery affected by aneurysm

A

Splenic artery

282
Q

Blood supply of anterior abdominal wall

A

Superior and Inferior epiGastric arteries
Lower intercostal arteries
Circumflex Iliac arteries

283
Q

Most frequent site of rupture of appendix

A

Antimesenteric border

284
Q

MC cause of appendiceal lumen obstruction in children and young adults

A

Lymphoid hyperplasia from submucosal follicles

285
Q

Elderly woman with SBO
Medial thigh pain
Palpable mass on lateral rectal wall
Dx?

A

Obturator hernia

286
Q

Systemic disease can cause lymphoid hyperplasia in appendix

A

Gastroenteritis from Shigella and Salmonella
URTI
Infectious Mono and Measles

287
Q

Borders of Femoral Canal

A

Superior and Medial - Iliopubic tract
Inferior - Cooper’s ligament
Lateral - Femoral vein

288
Q

UTZ - appendix diameter >6mm,
Noncompressibility
Presence of complex mass

A

UTZ finding in Acute appendicitis

289
Q

MC organisms found in wound infections after appendectomy

A

Bacteroides
Enterobacter
Klebsiella
E. Coli

“BEKE”

290
Q

MC cause of intestinal obstruction world wide

A

Hernias

291
Q

Lower edge of posterior rectus sheath, approx 3-6cm below level of umbilicus

A

Linea semicircularis

292
Q

Curved depression seen lateral to the rectus abdominis

A

Linea semilunaris (Line of Douglas)

293
Q

Pain on internal rotation of right hip

A

Obturator sign

294
Q

Hernia, where one of the contents includes 1 side (usually antimesenteric side) of intestinal wall.

This hernia strangulates without any evidence of intestinal obstruction and is easy to miss

A

Richter’s hernia

295
Q

Hernia, part of the wall of the sac consists of a viscus (urinary bladder, cecum etc)

A

Sliding hernia

296
Q

Triangle of Dooom

A

Area between the Vas deferens and gonadal vessels seen on laparoscopic approach where, for example, the Iliac vessels are at risk of injury from staples

297
Q

Intraabdominal hernia to the left of SMV creating a closed-loop bowel obstruction

A

Paraduodenal (Treitz) hernia

298
Q

Hernia sac contains ruptured appendix
Usually mistaken with strangulated hernia

A

Amyand’s hernia

299
Q

Structures derived from external oblique muscle and aponeurosis

A

Inguinal Ligament
Lacunar ligament
Superficial inguinal ring

300
Q

Inguinal hernia with incarcerated Meckel’s diverticulum

A

Littre’s hernia

301
Q

Boundaries of superior lumbar triangle of Grynfelt

A

Superior - 12th rib
Inferior - internal oblique muscle
Posterior - sacrospinalis muscle

302
Q

Boundaries of inferior triangle of Petit

A

Posterior - Latissimus dorsi
Anterior - External oblique
Inferior - Iliac crest

303
Q

The relaxing incision in the transversus abdominis, superomedial to the inguinal canal, to relieve tension on the repair

A

Tanner’ slide operation

304
Q

Usual content of epigastric hernia

A

Preperitoneal fat

305
Q

Pain passing down the inner side of the thigh to the knee in an obturator hernia with internal thigh rotation

A

Howdhip Romberg sign

306
Q

Primary nutrition source for colon and small bowel

A

Colon - short chain FA
Small bowel - glutamine

307
Q

During inflammatory phase of wound healing, what chemotactic factors attract neutrophils to the wound

A

Complement componens C5a and PDGF

308
Q

K/cal contents of carbs/protein/fat

A

Carbs - 3.4
Protein - 4
Fat - 9

309
Q

Single best measure of nutritional status

A

Serum albumin level

310
Q

It stimulates growth of fibroblasts and inhibits growth of epithelial cells

It enhances angiogenesis

A

Transforming Growth Factor-beta (TGF-beta)

311
Q

Where are branched chain amino acids metabolized

A

Muscle

312
Q

Products of platelet degranulation

A

TGF-beta and PDGF

313
Q

Child with edema
Variable weight
Hypoalbuminemia

A

Kwashiorkor (acute visceral protein depletion)

314
Q

Primary cell regulating collagen synthesis

A

Macrophage

315
Q

Cell secretes PRO-ALPHA COLLAGEN CHAINS

A

Fibroblasts

316
Q

How is serum protein maintained kn fasting

A

By hepatic conversion of FA to ketone bodies

317
Q

Dominant cell type during inflammatory phase of wound healing

A

Macrophage

318
Q

Best measurement of marginal malnutrition

A

Retinal-binding prealbumin

319
Q

What electrolyte should be inspected if difficulty correcting patient’s low Ca

A

Magnesium

320
Q

Hormone normally regulates protein synthesis and breakdown

A

Insulin

321
Q

Amino acid, key fuel for rapidly dividing cells, including cancer cells

A

GLUTamine

322
Q

Stimulates DNA synthesis and cell division in a variety of cells, including fibroblasts, keratinocytes and endothelial cells

A

Epidermal Growth Factor (EGF)

323
Q

Cell produces GM-CSF

A

Activated T lymphocytes

324
Q

Predominant type of collagen in scar tissue

A

Type 1

325
Q

Facilitates epithelial cell anchoring

A

Laminin

326
Q

This can reduce lean body mass and protein loss in children with large surface area burns

A

Synthetic testosterone (Oxandrolone) and Propranolol

327
Q

What cells produce Interferon (IFN)?

A

Lymphocytes and fibroblasts

328
Q

Amino acid considered vital to the immune system

A

Arginine

329
Q

Most common organism associated withcatherlter sepsis from long term TPN

A

Staphylococcus aureus

330
Q

Amino acid precursor of Gluconeogenesis

A

Alanine

331
Q

Nutritional deficiency if patient has unexplained lactic acidosis

A

Thiamin

332
Q

Earliest metabolic signs of systemic sepsis

A

Glucose intolerance

333
Q

Multitrace elements as MTE-5
5 elements

A

Zinc
Copper
Chromium
Manganese
Selenium

334
Q

Vitamin deficiency caused by gastric or ileal resection

A

Vit B12

335
Q

Elemental deficiencies associated with gastric bypass surgery

A

Iron deficiency — duodenal bypass = microcytic anemia
Vit B12 deficiency — gastric resection = lack of intrinsic factor

336
Q

Electrolyte deficiency for inducing post-CABG ventricular tachycardia

A

HypOMagnesemia

337
Q

Marker of visceral protein stores

A

Transferrin

338
Q

Test that can predict the need for stress dose steroids perioperatively in a patient with recent steroid use

A

ACTH stimulation test

339
Q

At normal body temp, what is the average daily insensible water loss?

A

600-900 mL/d or 8-12 mL/kg/d

340
Q

Hallmarks of hypOkalemia

A

Respiratory impairment
Paralysis
Hyporeflexia
Flat T waves
Depressed ST segment

341
Q

Common causes of hyperosmolar hypONatremia

A

Hyperglycemia
Mannitol
Radiologic contrast

342
Q

Primary electrolyte effects of aldosterone

A

Sodium retention and urinary potassium and hydrogen ion loss

343
Q

Medications can increase serum K

A

Beta blockers
ACE inhibitors

344
Q

Electrolyte deficiency associated with acute pancreatitis

A

HypOCalcemia (2nd 24hr Ranson criteria)

345
Q

Severe hyperkalemia

A

Peaked T wave

Tx with Ca to stabilize the cardiac membrane

346
Q

Electrolyte abnormality associated with vomiting and NG suctioning

A

HypOKalemic
HypOChlosremic
Metabolic Acidosis

Tx with saline and potassium

347
Q

Overly rapid correction of Hyponatremia causes

A

Central pontine myelinosis

348
Q

Overly rapid correction of hypernatremia causes

A

Cerebral edema

349
Q

At or above which nerve root is respiratory failure worsened in spi al injury

A

C2

350
Q

Hemodynamic parameters associated with sepsis

A

Low SVR
High CO
Normal PCWP

351
Q

Palmar blush within 7 secs of ulnar artery release

A

Normal Allen test

352
Q

Typical PA catheter measurement in hypovolemic shock

A

Low CO
High SVR
Low PCWP

353
Q

Drug effective againts aerobic gram neg bacilli (pseudomonas), enterococci, staph, strep
MOA: inhibit ribosome function
Risks: prolonged neuromuscular blockade, ototoxicity, nephrotoxicity

A

Aminoglycosides

354
Q

MoA of bacterial resistance to aminoglycosides

A

Inhibition of active transport of the drug into the bacterial cell

355
Q

Red man syndrome

A

Vancomycin

356
Q

Mechanism of bacterial resistance to vancomycin

A

Altered bacterial cell walls

357
Q

Agent used to treat Vancomycin resistant enterococci (VRE)

A

Linezolid
Chloramphenicol
Novobiocin
Synercid
Teichoplanin
Quinolones
Doxycycline

358
Q

Major intracellular anions

A

Proteins
Phosphates

359
Q

Burn patients
Green slime infection on burns
Sweet smell

A

Pseudomonas

360
Q

Mitral valve abnormalities can lead to large v waves on PA wedge tracing

A

Mitral stenosis
Mitral regurgitation
—d/t overfilling of left atrium

361
Q

How to diagnose VAP

A

BAL - bronchoalveolar lavage

362
Q

Variables determining O2 content

A

Hgb
O2 sat
PaO2

363
Q

% of available oxygen extracted by heart

A

70%
The coronary sinus has the LOWEST PO2 of any vessel in the body

364
Q

Physiologic effect of CPAP

A

Increase FRC and VC associated with decreases work of breathing

365
Q

Mortality rate for patients with multiple organ failure (MOF) complicated by acute renal failure

A

75 to 90%

366
Q

Acute compensation for metabolic acidosis

A

Respiratory (hyperventilation) alkalosis

367
Q

Role of pressure control ventilation (PCV)

A

To minimize ventilator-associated barotraumas by delivering vol until a set peak airway pressure is reached. Of greatest utility in ARDS and requires paralysis with heavy sedation

368
Q

Pitfall of PANCURONIUM as in ICU paralytic agent

A

Hepatic metab and renal excretion make prolonged neuromuscular blockage a concern in patients with multisystem organ failure

CISATRACURIUM is metabolized by pseudocholinesyerase and thus has become the ICU paralytic agent of choice

369
Q

MC cause of hypercalcemia

A

Hyoeroarathyroidism
Cancer with bony metastases

370
Q

Where does EDRF arise

A

It is nitric oxide and released from endothelial cells
NO precursor is arginine
NO is a smooth muscle relaxing factor and promote vasodilation

371
Q

MOA of Atrial Natriuretic Peptide (ANP)

A

Sodium overload and retention rsults in vol overload that distends the atria. Atria then release ANP, which causes an increase in renal vasodilatation and natrouresis

372
Q

Prostaglandins in sodium homeostasis

A

Prostaglandin synthesis is increased in states of absolute effective volume depletion and serves to maintain GFR and excretion of salt and water.
Inhibition of prostaglandin synthesis (NSAIDs) under these circumstances can lead to a decline in GFR and sodium overload.

373
Q

Perioral numbness/tingling
Hyperactive deep tenson reflex
Cvostek’s sign
Trousseau sign

A

Classic signs of HYPOCALCEMIA

374
Q

Hypertensive, hypokalemic syndromes

A

Primary HypEr aldosteronism
2ndary HypEr aldosteronism
Cushing syndrome

375
Q

Dx of PE
Area of lung consolidation with rounded border facing the hilus

A

Hampton’s hump

376
Q

Dx of PE
Dilated pulmonary outflow tract ipsipateral to emboli with decreased perfusion distal to lesion

A

Westermark’s sign

377
Q

Most reliable measure of glomerular filtration

A

Creatinine clearance

378
Q

Common pathophysiologic pathway of ARDS

A

Injury to alveolar-capillary interface

379
Q

Weakness
Twitching
Lethargy
Obtundation
Irritability
Seizures
Cerebral hemorrhage

A

HyperNAtremia

380
Q

MC cause of volume deficit encountered in surgery

A

Loss of isotonic fluid

381
Q

Conditions where CO2 production increased

A

Lipogenesis
Fever
Hyperthyroidism

382
Q

Class of hemorrhagic shoch consistent with a drop in systolic BP

A

Class III

383
Q

Class of hemorrhagic shock with loss of 15% to 30% of circulating blood volume, tachycardia, and decrease pulse pressure

A

Class II

384
Q

Preferred position of patients suspected of ahving air embolism

A

Left lateral decubitus

385
Q

Best initial fluid management for patient with hemorrhagic shock

A

Lactated ringer

386
Q

Best initial fluid management for patient with hemorrhagic shock

A

Lactated ringer

387
Q

Best initial fluid management for patient with hemorrhagic shock

A

Lactated ringer

388
Q

Treatment options for patients with massive PE and acute cor pulmonale

A

Volume resuscitation and vasopressors
Then heparin, thrombolytics or surgical embolectomy

389
Q

MC cause of cardiogenic shock in the setting of an acute MI

A

Greater than 40% loss of LV myocardium
Ventricular wall rupture
Septal rupture
LV aneurysm
Acute mitral regurgitation caused by papillary muscle rupture or dysfunction

390
Q

Pt BP drops significantly after administration of nitroglycerin in the setting of an acute MI

A

Inferior wall MI w/ RV involvement

391
Q

Main determinant of serum osmolarity of ECF space

A

Serum sodium concentration

392
Q

Complications in massive blood transfusion

A

Electrolyte and acid-base abnormalities (alkalosis)
Changes in hemoglobin-oxygen affinity (decreased 2,3 DPG)
Hypothermia
Dilutional coagulopathy

393
Q

Complications in massive blood transfusion

A

Electrolyte and acid-base abnormalities (alkalosis)
Changes in hemoglobin-oxygen affinity (decreased 2,3 DPG)
Hypothermia
Dilutional coagulopathy

394
Q

Major source of tumor necrosis factor (TNF) following hypoperfusion

A

Liver and gut

395
Q

Major source of tumor necrosis factor (TNF) following hypoperfusion

A

Liver and gut

396
Q

TOC for wide complex tachycardia of uncertain etiology

A

Amiodarone or Lidocaine

397
Q

Pt presents with inferior wall MI
Now hypotensive
Distended neck vein
Clear lung fields
Dx?

A

RV infarct or ischemia

398
Q

TOC for hyperKalemia-induced cardiac arrythmia

A

IV calcium gluconate

399
Q

Normal dietary intake of potassium

A

50-100 mEq/d

400
Q

A mass of bowel and solid viscera in the central abdomen covered by translucent peritoneal covering membrane

A

Omphalocele

— more frequently associated with congenital anomalies

401
Q

Absence of peritoneal covering
Abdominal wall defect typically to the RIGHT of midline
Typically only small bowel herniated

A

Gastroschisis

402
Q

Primary closure of gastroschisis

A

Intragastric pressure <20cm H2O and
CVP does not increase by 4mmHg or more

403
Q

Type of renal calculi associated with hx of Distal Ileum resection

A

Calcium Oxalate stones

404
Q

Type of renal calculi associated with hx of Distal Ileum resection

A

Calcium Oxalate stones

405
Q

MC site of ureteral injury

A
  • Near pelvic brim
  • INFUNDIBULOPELVIC LIGAMENT
  • base of broad lig where ureter crosses the uterine artery
  • URETOVESICAL junction where ureter moves medially to insert into bladder
406
Q

During hysterectomy, when do most ureteral injury occur

A

During clamping the uterine vessels or ligation of infundibulopelvic ligaments

407
Q

Pt with varicocele of left testicle

A

Check for retroperitoneal or renal mass because left gonadal vein drains into L renal vein

408
Q

Surgical precedure MC results in vesicovaginal fistulas

A

Rotal abdominal or vaginal hysterectomy

409
Q

Trauma patient has blood at urethral meatus and hig-riding prostate
What test to order?

A

Retrograde urethrogram before placing the Foley.
If urethral disruption has occured, suprapubic cystostomy should be placed

410
Q

Difference of L and R ureters in their pelvic course

A

Left ureter enters pelvis and cross common iliac artery MORE MEDIALLY thank the right ureter

411
Q

MC cause of painless hematuria in children

A

Glomerular lesion

412
Q

Function of ANP (atrial natriuretic peptide)

A

Relaxes vascular smooth muscle
Decrease sympathetic stimulation and inhibits renin and aldosterone secretion

413
Q

MC cause of acute left varicocele

A

Renal vein occlusion (commonly related to renal tumors)

414
Q

Severe testicular pain

A

Testicular torsion
Must be corrected within 4HOURS before irreversible damage occurs

415
Q

Kidney stone associated with perinephric abscesses

A

Struvite or staghorn calculi

416
Q

MC manifestation of metastatic gonococcal infection

A

Gonococcal arthritis

417
Q

Kidney stone associated with primary hyperparathyroidism

A

Hydorxyapatite crystal predominance

418
Q

Percentage of urinary tract stones are radiopaque

A

90%

419
Q

Best test to detect prostate cancer

A

DRE and PSA

420
Q

MOA of Alpha blockers (flomax) in tx of BPH

A

Relax smooth muscle and partially relieve the dynamic component of obstruction

421
Q

MC cancer affecting kidney

A

Renal cell Carcinoma

422
Q

MC cancer affecting kidneys in childhood

A

Wilm’s tumor (adenomyosarcoma)

423
Q

Triad of
Pain
Palpable mass
Hematuria

A

Renal tumor

Occurs late

424
Q

MC tumor affecting renal pelvocalyceal system

A

Transitional cell carcinoma

425
Q

55yo male
Gross hematuria
Renal colic
IVP - filling defect in left mid ureter
Dx?

A

Transitional cell carcinoma

426
Q

MC testicular tumor in older male

Most RADIOSENSITIVE

A

Seminoma

427
Q

Testicular tumor with WORST prognosis

A

Choricarcinoma

428
Q

Tumor markers to check before orchiectomy

A

HCG (seminomatous)
AFP (nonseminomatous)
Obtain abdominal CT staging before surgery

429
Q

Sperm count of a healthy male

A

Between 30 and 100 million sperm/mL with at least 70% showing purposeful motility

430
Q

Indications for sx who sustained traumatic renal injury

A

Urinary extravasation
IV contrast blush on CT outside renal capsule
Persistent retroperitoneal bleeding
Nonviable tissue

431
Q

Best sx approach for renal exploration after trauma

A

Midline abdominal

432
Q

MC cause of ureteral injury

A

Iatrogenic injury during abdominal procedure

433
Q

MC cause of traumatic bladder injury

A

Pelvic fracture with penetration of bladder by bone spicules

434
Q

MC cause of urethral injury

A

Pelvic fracture or perineal penetration (saddle injury)

435
Q

MC fusion defect of urethra

A

Hypospadias

436
Q

MC location of urethral meatus in patient with hypospadias

A

Distal end of penile shaft, ANTERIORLY

437
Q

Standard oncologic procedure for ovarian cancer

A

TAH/BSO, omentectomy and peritoneal fluid cytology
Peritoneal surface serosal debulking

Ovarian CA is the LEADING FATAL GYN MALIGNANCY caused by typical advanced stage and presentation

438
Q

MC neoplasm in reproductive-aged woman

A

Benign leiomyoma

439
Q

Best predictor of recurrence-free interval for early stage leiomyosarcomas

A

Mitotic index

440
Q

Side effect of Tamoxifen (anti-breast CA drug)

A

Increase risk of endometrial CA and uterine sarcoma
Increased DVT rate
Cataract formation

441
Q

Side effect of postmenopausal hormone supplementation (estrogen/progesterone)

A

Increase rate of CAD
Breast CA
Endometrial CA

442
Q

Benefits of postmenopausal hormone supplementation (estrogen/progesterone)

A

Decreased rate of Osteoporosis
Colorectal cancer

443
Q

MC complaint of women with cervical cancer

A

Menorrhagia

444
Q

MC site of ecropic pregnancy

A

Ampulla of fallopian tube

445
Q

6yo
Prematur thelarche
Tanner stage 4 breast
Cafe au lait spots
Ovarian cysts

A

McCune-Albright syndrome

446
Q

MC cailuse of Otitis media in newborn

A

E. Coli

447
Q

MC cause of stridor in newborn

A

Laryngomalacia

448
Q

MC malignant salivary tumor

A

Mucoepidermoid CA

449
Q

MC malignant salivary gland tumor of submandibular glands

A

Adenoid cystic carcinoma

450
Q

MC benign salivary tumor

A
  1. Pleomorphic adenoma
  2. Warthin’s tumor (10% bilateral)
451
Q

Part of airway with greeatest degree of inflammation in child with laryngotracheobromchitis (croup)

A

Subglottic region

452
Q

Illa appearing patient
Fever
Bilateral chemosis
3rd nerve palsy
Sinusitis
Dx?

A

Cavernous sinus thrombosis

453
Q

MC type of malignant neoplasms of nasopharynx in adults

A

Squamous cell CA

454
Q

48yo male
High fever
Trismus
Dysphagia
Swelling inferior to mandible in lateral neck
Dx?

A

Parapharyngeal abscess

455
Q

Structures removed in classical radical neck dissection

A

SCM
Internal Jugular Vein
Spinal accessory nerve
Submandibula salivary gland w/ associated lymph node bearing fibro fatty tissue

456
Q

MC cause of acute otitis media in children

A

S. Pneumoniae
Haemophilus influenza
Moraxella catarrhalis

457
Q

Salivary gland stones most common location

A

Submandibular gland

458
Q

Clinical features of basal cell carcinoma

A

Raised, waxy nodule with occasional erythema

459
Q

Household prophylaxis with acute epiglottitis

A

Rifampin 20mg/kg (max 600mg) for 4 days

460
Q

Prevertebral soft-tissue widening
Airfluid levels
Loss of cervical lordosis
Cervical osteomyelitis
Dx?

A

Retropharyngeal abscess

461
Q

Lateral neck mass (posterior triangle)
Mass is soft and transilluminates
Excision is recommended

A

Cystic hygroma

462
Q

Lateral neck mass (anterior border of SCM)
More firm
Causes skin buckling or indent

A

Brachial cleft cyst

463
Q

MC bacterial cause of acute sinusitis

A

Pneumococcus
H. Influenza

464
Q

MC bacterial cause of malignant external otitis

A

Pseudomonas aeruginosa

465
Q

Most frequent neuro complication of malignant external otitis

A

Facial nerve palsy

466
Q

MC organism associated with acute suppurative parotitis

A

Staphylococcus aureus

467
Q

Recurrent, painful swelling of the side of the face at lealtime
Resolves withi 2-3 hrs
Dx?

A

Sialolithiasis

468
Q

Superior laryngeal nerve injury results to

A

Loss of sensation above vocal cords
Impairment of laryngeal protective reflexes
Hoarseness
Limited vocalization of high pitched tones (external branch)

469
Q

Salivary gland tumor has well known propensity for extension along perineural spaces and invasion of bone

A

Adenoid cystic carcinoma

470
Q

Cranial nerve derivative of 2nd brachial arch

A

VII (geniculatr ganglion)

471
Q

4th and 6th arch derivatives innervated by?

A

4th - Superior laryngeal nerve
6th - Recurrent laryngeal nerve

472
Q

Nystagmus component

A

Fast component
Slow phase - vestibular origin, direction of endolymph flow
Fast phase - compensatory from reticular formation

473
Q

MC site of salivary gland tumors

A

Parotid gland

474
Q

MC malignant tumor of parotid gland

A

Mucoepidermoid carcinoma

475
Q

MC malignant tumor of submandibular gland

A

Adenoid cystic carcinoma

476
Q

Painless mass below ear
Slowly enlarging for 2-3 years
Patho: plump, round, granular eosinophilic cells with small indented nuclei
Dx?

A

Warthins tumor (adenolymphoma)
2nd MC parotid malignancy overall

477
Q

Sensory distribution of which CN is responsible for the sensory distribution of referred otalgia

A

CN 5, 9, 10

478
Q

Sole abductor of the vocal cords

A

Posterior CricoArytenoid

479
Q

Intrinsic laryngeal muscles responsible for tension of vocal cords

A

CricoThyroid (Chief Tensor)
ThyroArytenoid (Internal Tensor)

480
Q

6yo
Dysphagia
Fever
Noisy breathing
Muffled voice
Neck is stiff
Rigid posturing of his head

A

RetroPharyngeal abscess

481
Q

Location of parathyroid gland in a 10yo with lingual thyroid gland

A

TracheoEsophageal groove

482
Q

Infant
Triad of:
Coughing
Choking
Cyanosis during feeding

A

Tracheoesophageal fistula

483
Q

MC source of anterior epistaxis

A

Septal branches of SphenoPalatine artery and branches of Anterior Ethmoidal and Facial arteries

484
Q

CN affected in skull base lesion

A

CN 7 and 8

485
Q

MC lesion of cerebellopontine angle or skulll base

A

Acoustic neuroma
—1st finding: unilateral sensorineural hearing loss

486
Q

Which lip commonly affected by sun exposure induced carcinoma

A

Lower lip

487
Q

MC histopath for lip cancer

A

SCC

488
Q

Syndrome associated with post cricoid carcinoma in nonsmoking young women

A

Plummer vinson syndrome

489
Q

Anatomically divides zones 3 and zone 4

A

Omohyoid muscle

490
Q

MC cause of CSF leak

A

Basilar skull fractures

491
Q

Therapy for patient with Hemophilia A who suffered traumatic brain trauma

A

Cryoprecipitate

492
Q

Subdural vs epidural hematoma
More deadly?

A

Subdural hematoma

493
Q

MC primary malignant brain tumor

A

Glioblastoma multiforme (GBM)

494
Q

Segment of vertebral artery most frequently involved in traumatic dissection

A

Segment between 2nd cervical veryebra and occiput (3rd portion of vertebral artery)

495
Q

MC type of Odontoid Fracture

A

Type II (fracture through base of dens)

496
Q

Spinal abnormality in patients with Rheumatoid arthritis

A

Atlantoaxial subluxation

497
Q

Penetrating trauma with ½ cord transection
Loss of ipsilateral motor and contralateral pani and temp

A

Brown sequard syndrome

498
Q

MVA of elderly patients w/ HYPEREXTENSION injury.
Bilateral loss of upper extremity motor pain and temp
Leg retain function

A

Central cord syndrome

499
Q

Bilateral facial paralysis associated with progressive ASCENDING motor neuropathy of lower extremity and elevated CSF protein characteristic of

A

Guillian-Barre syndrome

500
Q

Bilateral acoustic neuromas

A

Neurofibromatosis II

501
Q

Single or multiple sharply circumscribed osteolytic lesions most frequently found on the skull

A

Histiocytosis X

502
Q

HIV (+)
Seizure
2 ring-enhancing brain lesions
Dx?

A

Toxoplasmosis or
CNS lymphoma

503
Q

Pt w/ 3rd nerve palsy
Recent episode of excruciating headache
Dx?

A

Posterior Communicating Artery Aneurysm

504
Q

Phenomenon in the setting of uncal herniation where temporal lobe herniation displaces the brainstem against the opposite tentorial edge and causes symptoms of contralateral brainstem injury and ipsilateral hemiparesis

A

Kernohan’s notch syndrome

505
Q

Primary toxicity risk of HALOTHANE anesthesia

A

Hepatitis w/ fever
Eosinophilia
Jaundice

506
Q

Antiemetic agent increases gastric motility

A

Reglan (Metoclopramide)

507
Q

Sedation agent in children that increases cardiac work, secretions, and BP and is NOT associated with respiratory depression

A

Ketamine

508
Q

Muscle first to recover from paralytic therapy

A

Diaphragm

509
Q

Lidocaine toxicity

A

Neurologic signs - paresthesia, headache and tinnitus
For general or MAC anesthesia, cardiac arrythmia 1st sign

510
Q

Toxic dose of lidocaine

A

No epi - 5mg/kg
W/ epi - 7mg/kg

511
Q

Medicine associated with decrease splanchnic blood flow
- used in GI bleeds

A

VASOPRESSIN

512
Q

Patients that may have detrimental side effects from SUCCINYLCHOLINE

A

Closed angle glaucoma
Space occupying intracranial lesions
Severe crush injuries of lower ex

513
Q

Treatment for MALIGNANT HYPERTHERMIA

A

cessation of anesthesia
DANTROLENE
general supportive measures

514
Q

Primary toxicity of MEPERIDINE (Demerol)

A

Neurotoxic metabolites (accumulates in pt with renal insufficiency)
Papillary dilation
Seizures

515
Q

Best time to administer oral RANITIDINE for prophylaxis againts acid aspiration

A

60 mins before induction of anesthesia

516
Q

Single most important factor predicting postoperative cardiac morbidity

A

Hx of Congestive Heart Failure (CHF)

517
Q

Potential adverse side effect of PROPOFOL

A

Hypertriglyceridemia w/ chronic use
Vasodilation
Hypotension
Respiratory depression

518
Q

MOA of METOCLOPRAMIDE

A

Inhibits dopamine and enhances the release of acetylcholine, resulting in an increased rate of gastric emtying and increased LES tone.
Inhibits chemoreceptor zone

519
Q

Extrapyramidal effects of DROPERIDOL

A

Acute dystonia
Parkinsonism
Akathesia

520
Q

Single most important factor that determines the length of stay after general anesthesia in ambulatory patients.

A

Postanesthesia nausea

521
Q

How NEOSTIGMINE decrease postop nausea and vomiting

A

Increases LES pressure and counteracts the increased risk of regurgitation of gastric contents after atropine administration

522
Q

MC peripheral nerve injury associated with prolonged general anesthesia

A

ULNAR neuropathy from prolonged compression of elbow

523
Q

Result of intra arterial injection of THIOPENTAL

A

Crystal formation and local Norepi release that may culminate in thrombosis and severe ischemia of extelremity

524
Q

Factors determine cerebral blood flow

A

Arterial CO2
O2 tension
Systemic arterial BP
Head position
Jugular venous obstruction
Positive end-expiratory pressure (PEEP)

525
Q

Moat sensitive indicator of a falling cardiac output (CO) during surgery

A

Mixed venous oxygen tension will DECREASE

526
Q

Core body temp cardiac arrhthmia begin to occur

A

23 C

527
Q

Inhalation agent worst offender in terms of sensitizing the myocardium to catecholamines

A

Halothane

528
Q

Only neuromuscular blocking agent essentially devoid of cardiovascular side effects

Best in ambulatory patient who is particularly sensitive to blood pressure changes

A

Vecuronium

529
Q

Local anesthetic has the longest half-life

A

Bupivacaine (marcaine)
4-6 hrs total duration

530
Q

Advantage of PROPOFOL instead of thipental for induction &/or maintenance in pedia patients undergoing ambulatory surgery

A

Well tolerated technique in children
Superior recovery
Extremely low incidence of vomiting

531
Q

SEVOFLURANE vs isoflurane in adult ambulatory surgical patients

A

Faster recovery and decrease side effects

532
Q

Landmarks in performing a midline lumbar spinal block

A

Iliac crest and
L4 and L5 spinal process
(And/or L3 spinous process)

533
Q

Feared toxicity of KETOROLAC

A

Renal toxicity

534
Q

Best parameter in predicting successful weaning from mechanical ventilation

A

Rapid shallow breathing index(RR/TV)

535
Q

Factors can impair phagocytosis of bacteria

A

Bacterial encapsulation
Uremia
Prematurity
Leukemia
Hyperglycemia

536
Q

Toxic portion of endotoxin LipoPolySaccharide protein complex

A

Lipid A

537
Q

MOA of quinolones

A

Inhibit DNA gyrase , which is needed to package DNA into dividing bacteria

538
Q

Best time to begin prophylactic antibiotic therapy for elective surgery

A

Within 1hour prior to operation

539
Q

MC inciting bacteria for burn wound infection

A

1st week - S. aureus
After weeks of hospitalization - Gram neg Pseudomonas

540
Q

48h post op
Severe pain in midline wound
Skin bullae
CREPITUS
Irregular blanching at wound margin
Fever 104F
Dx?

A

Clostridial gas gangrene
Clostridium perfringes
Tx: pen G / Clindamycin in PCN allergic patients
+ emergent surgical debridement
Monitor urine for signs of hemolysis

541
Q

Proper tx for iatrogenic transection of CBD

A

End to end anastomosis (EEA) over a T-tube stent when portion of CBD is injured or choledocojejunostomy for complete CBD transection

542
Q

Structure most commonly injured if Triangle of Calot is not identified during cholecystectomy

A

Right Hepatic Artery

543
Q

TOF patient with amebic liver abscess

A

Metronidazole

544
Q

MC cause of small bowel obstruction

A

Small bowel adhesion

545
Q

Severe wt loss
Steatorrhea
Hx extensive small bowel resection
Cause of symptoms?

A

Resection of ILEUM (insufficient bile salt absorption)

546
Q

Initial therapy for patients with Clostridium difficile colitis

A

Oral Metronidazole or Vancomycin

W/severe ileus - IV Metro/Vanco

***Metro contraindicated with pregnant!!

547
Q

Appropriate surgical therapy for toxic C. difficile with Toxic Megacolon

A

Total colectomy and End Ileostomy
Clinical signs:
Colonic pneumonitis
Portal circulation gas
Peritonitis
Sepsis

548
Q

Bacteria most commonly reported as the sole cause of NONCLOSTRIDIAL NECROTIZING SOFT-TISSUE INFECTION

A

Group A beta-hemolytic Streptococcus

549
Q

Tx for diabetic foot w/osteomyelitis, scending cellulitis of lower leg and systemic signs of sepsis

A

Guillotine amputation below the leg

550
Q

MC organism associated w peritonitis in patients receiving peritoneal dialysis

A

S. aureus
S. epidermidis

551
Q

Fungal infection in immunocompromised (lungs)
Airborn transmission
Once in the lung, disseminate to bone and soft tissue necrotizing effect can occur

A

Aspergillosis clinical features

BOARD REVIEW (19 decks)

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