ABSITE Flashcards
(162 cards)
1
Q
TEG: R
A
Greater 10 min
[FFP]
2
Q
TEG: K
A
Greater 3 min
[Cryo]
3
Q
TEG: α Angle
A
Less 53
[Cryo & Plt]
4
Q
TEG: MA
A
Less 50 mm
[Plts, DDAVP]
5
Q
TEG: LY30
A
Greater 3%
[TXA]
6
Q
BIRADS 0
A
Incomplete
Repeat Mammo or U/S
7
Q
BIRADS1
A
Negative
Routine screening
8
Q
BIRADS 2
A
Benign
Routine Screening
9
Q
BIRADS 3
A
Probably
Benign
6 Month follow up
10
Q
BIRADS 4
A
Suspicious
Tissue Diagnosis
11
Q
BIRADS 5
A
High likelihood of malignancy
Tissue diagnosis
12
Q
BIRADS 6
A
Biopsy proven malignancy
Excision
13
Q
Bethesda I
A
Nondiagnostic
Repeat FNA
14
Q
Bethesda II
A
Benign
Clinical or U/S follow up
15
Q
Bethesda III
A
AUS/FLUS
Repeat FNA
Lobectomy/Molecular testing
16
Q
Bethesda IV
A
Follicular Neoplasm (FN)/SFN
Molecular testing/Lobectomy
17
Q
Bethesda V
A
Suspicious for Malignancy
Total/Lobectomy
18
Q
Bethesda VI
A
Biopsy proven malignancy
Total/Lobectomy
19
Q
Male Breast Cancer
A
MRM
Aromatase inhibitor
20
Q
Inflammatory Breast Cancer
A
Neoadjuvant CT -> MRM -> ALND -> Adjuvant XRT
21
Q
Paget Breast
A
MRM, Nipple-Areolar Complex
Palpable:MRM
Nonpalpable: Lumpectomy w/ Nipple-Areolar complex + Radiation
22
Q
Invasive ductal carcinoma borders
A
No ink on tumor
23
Q
DCIS Borders
A
2 mm
24
Q
Her2neu (+)
A
Neoadjuvant (Traszumemab) + BCT
25
DCIS Treatment (Female vs Male)
Female: BCT + Endocrine + Radiation
Male: Mastectomy
No ALDN unless:
>4 cm
Palpable mass
Prior Mastectomy
Microinvasion
26
Li Fraumeni
[p53]
Leukemia
Breast
Adenocarcinoma
Sarcoma
27
PCI Scoring
T1 is a PCI score 1-10,
T2 is a PCI score 11-20
T3 is a PCI score 21-30
T4 is a PCI score 31-39
LS0: No tumor;
LS1: Tumor up to 0.5 cm
LS2: Tumor b/w 0.5 - 5.0 cm
LS3: Tumor >5 cm or confluent tumor
28
When primary Esophagus can be repaired primary in TEF
Gap is <2 vertebral bones
29
Compartment syndrome
12 mm Hg (Increase pressure)
20 mm Hg (Organ failure)
30
High risk IPMN
1. jaundice
2. enhancing solid component
3. MD >1 cm
31
Worrisome IPMN
1. Size >3 cm
2. Thickened enhancing cyst walls
3. MD 5 - 9 mm
4. Nonenhancing mural nodules
5. Abrupt caliber change
6. Lymphadenopathy
7. Pancreatitis
32
Contraindication to total or head pancreatic resection
Splenic or portal vein thrombosis
(Causes significant operative bleeding due to recanalization)
33
Long term Blind loop sydrome
Due to B2
Medium chain Triglycerides + B12
34
Muir-Torre syndrome
GI
GU
Breast
(MLH1, MSH2)
35
Cowden syndrome
* Mucocutaneous
* Endometrial
* Thyroid
* Breast
(PTEN)
36
Gastrectomy margins
Proximal 6 cm
Distal 2 cm
37
Triple negative Breast CA
Lumpectomy + Adjuvant XT + Radiation
38
Time span anal nodule needs to be present before biopsy
6 Months
39
Papillary Thyroid Ca Stage III or IV
Age >55 yrs
40
Size of thyroid nodule not needing FNA
<1 cm(10 mm)
41
Desmoplastic melanoma
Resection + Adjuvant radiation
42
Lidocaine dosing
w/ Epi 7 mg/Kg
w/o Epi 5 mg/Kg
43
Bupivicaine Dosing
2.5 mg/kg
44
Pancreatitis Surgery: Head
1. Frey
2. Berger
3. Whipple
45
Pancreatitis Surgery: Enlarged duct
Puestow
Frey
46
Side Effect: Etomidate
Adrenal Supression
47
Hoffman Elimination Nondepolarizing agents
Atracurium
Cisatracurium
(Hoffman elimination)
48
Bacitracin
Partial thickness burns
Nephrotoxic
49
Mupirocin
MRSA
50
Silvadene (Sulfadiazine)
Does not penetrate eschar
Prophylaxis
Neutropenia & Thrombocytopenia
51
Mafenide acetate
Full thickness burns
Penetrates eschar
Metaboli aidosis (carbonic anhydrase inhibitor)
52
Silver nitrate
Hyponatremia
53
Contraindication to lumpectomy
1. prior irradiation
2. pos margins
3. inflammatory
4. pregnancy (unless 3rd trimester)
54
What are the axillary node levels (1-3, and one more category)?
1 - lateral to pec minor
2 - beneath pec minor
3 - medial to pec minor
Rotter's Nodes - between pec major and pec minor
55
What do you do if you can't find radiotracer dye in SNLB?
ALND
56
What patient would get only mastectomy/BCT + tamoxifen for 5 years (4 characteristics)?
* (-) SLN
* old
* ER+
* tumor <2 cm
57
What patient would get mastectomy/BCT + tamoxifen for 5 years plus chemo (4 characteristics)?
* (-) SLN
* young
* ER+
* tumor >1cm
58
In what population should giant liver hemangioma be resected, how can it present in this population (name of syndrome and its 2 problems, other possible problem)?
pediatric population
kasabach-merit syndrome = hepatic sequestration and thrombocytopenia, AV shunting and heart failure
59
Indication for transanal excision (T stage, circumference, location, 2 criteria if invasive)?
stage I: polyp or T1
circumference: <40%
Location: within 8-10cm of anal verge
if invasive must be: 1) no lymphovascular invasion; 2) not poorly differentiated
60
Coloncyte fuel, and derived from where?
butyric acid
Short fatty acids
61
Carcinoid tumor rectum - Tx?
Transanal excision
62
Treatment for FAP?
1. TAC
2. Mucosal proctectomy
3. Pouch
63
MALToma - when is surgery first line treatment?
gastric outlet obstruction
64
MALTOMA: 1st, 2nd, 3rd line treatment?
1. Eradicate H pylori
2. Chemo/xrt
3. surgery
65
Gallbladder CA based on presentation
1. T1a (lamina propria): Cholecystecotmy
2. T1b>: en bloc resection of the gallbladder with at least a 2 cm margin of underlying liver bed (nonanatomic resection or anatomic resection of segments IVb and V), portal and hepatoduodenal lymphadenectomy
3. CBD excisiont if cystic duct involved
66
Treatment for types of choledochal cyst (1-5)?
Type I: Fusiform [Roux-en-Y hepatojejunostomy]
Type II: Diverticulum [Diverticulectomy]
Type III: Choledochal cyst [Endoscopic sphincterotomy]
Type IVa: Intra & extrahepatic [Transplant]
Type IVb: Extrahepatic [Roux-en-Y hepatojejunostomy]
Type V: Caroli disease (multiple intrahepatic) [Transplant]
67
Biliary injury: Segmental or accessory duct injury
<3 mm & Drainage
> 4 mm HJ
68
Biliary injury: Choledochotomy
Small: Simple repair
Large: T tube
Drainage
69
Biliary injury: CBD
Do not cut edges
HJ
70
Biliary injury: Short/ Long segment
Short: Repair over T tube
Long: HJ
71
Crohn's Small bowel stricture <5 cm
Endoscopic dilation
72
Crohn's Small bowel stricture > 5 cm
Heineke-Mikulicz strictureplasty >5cm
Finney strictureplasty >10 cm
Side-to-side isoperistaltic strictureplasty (SSIS) >20 cm
73
Treatment for varices with splenic vein thrombosis
Splenectomy
74
Timing of tranfusion of Platelets during Splenectomy
At induction
After ligation of Splenic artery
75
What myeloproliferative disorder benefits from splenectomy
myelofibrosis -- extramedullary hematopoeisis in spleen
76
Esophageal leyiomyoma
enuculation if >5cm or symptomatic
via Thoracotomy
77
Boerhave's treament early, late, deathly ill?
Early: Primary repair (L thoracotomy) +/- Jtube
Late: Spit fistula, J tube, delayed restoration of GI continuity
Deathly Ill: Mediastinal washout/drainage with definitive surgery when stable
78
Treatment for barrett's esophagus and high grade dysplasia?
Esophagectomy
79
Indications for preop neoadjuvant XRT in GE junction
cancer vs Surgery
Surgery if N0 T1-2
Neoadjuvant XRT if T3-4 or N+
80
Arterial supply for for esophagectomy?
Right gastroepiploic artery
81
lynch syndrome
(HNPCC)
DNA mismatch repair
MLH1, MSH2, MSH6, PMS2
Right sided colon ca
Endometrial ca, Small bowel, stomach, urinary tract, ovary, pancreas and brain
82
APR vs LAR
Need 2 cm margins in rectal cancer
83
Colon Ca: Surgery vs Neo XT
Surgery: N0, T1-2
Neo XT: T3/4, N+ (Stage II)
84
Indications for surgery in hyperthyroidism
* Large goiter
* Compressive symptoms
* Pregnant
* Failed medical therapy
* Autonomous thyroid nodule (Plummer syndrome)
85
Hurthle cell/follicular neoplasm
Cannot diagnose on FNA
Tx: Lobectomy
86
Preparation for I-131 scan
Hypothyroid for the scan
Stop thyroid hormone before scan (6 weeks for synthroid, 3 weeks for cytomel)
87
MEN-1 with hypercalcemia and a gastrinoma
Parathyroid > Gastrinoma
88
External branch of the superior laryngeal nerve: Location, innervation, injury
Superior thyroid artery
Cricothyroid
Weak voice, fatigue of voice at higher ranges
89
Hypercalcemia (>15mg/dl)
Palpable neck mass
Primary hyperPTH
Parathyroid Ca
90
Parathyroid Ca Tx
parthyroidectomy + ipsilateral
thyroid lobectomy
91
Missing parathyroid gland
1) carotid sheath
2) tracheoesophageal groove
3) perform transcervical thymectomy
4) Ipsilateral thyroid lobectomy
5) Close but bank tissue in case devascularized gland or find it in perma section
92
Vitamin Deficiency in TPN
Zinc
93
RQ for fat, protein, and carb?
Fat 0.7
Protein 0.8
Carbs 1.0
94
Frey Syndrome
Post gustatory sweating following parotidectomy
Auriculotemporal nerve damage
95
Femoral canal boundaries
Superior: Injuinal ligament
Medial: Lacunar ligament
Lateral: Femoral vein
Posterior: Iliacus, psoas tendons, fascia of pectineus
96
Testicular mass
U/S, B HCG, AFP
Tx: Inguinal orchietectomy
97
Humerus dislocation
No abduction
Axillary nerve
98
Radial nerve injury
Spiral humerus fx
supra and intercondylar fx
99
Trauma to fibular bone
Common peroneal nerve
100
Compression to lateral knee
Common peroneal nerve impingement
No dorsiflex
101
Worst perioperative sign on Goldman scale
Decompensated CHF
102
Where thoracic duct empties
LIJ & SVC
103
Crohns with normal appendix
Appendectomy unless cecum involved
104
Graft vs Host Disease
T cell mediated
105
Ectopic Pheochromocytoma
Para-aortic tissue
zuckercandl
106
Origin inferior parathyroid
3rd pharyngeal pouch
107
Hyperacute rejection
Anti-Donor Abs
108
Gastrochesis
Intestinal atresia
109
Omphalocele
Cardiac conditions
110
Cremasteric muscle
Internal oblique
111
Heparin
Potentiates Anti-Thrombin III
112
Abnormal fallopian tube during appendectomy
Appendectomy only
113
Antihypertensive for Pheochromocytoma
1) alpha blockade (phenoxybenzamine or prazosin)
2) beta blockade ( nonselective - labetolol)
114
Conn's Disease
Hypertension
HypoK
HyperNa
Metabolic Alkalosis
Renin: Aldosterone 0.015
115
Indications for surgery for Hepatic Adenoma
No resolution of mass following OCP cessation
Mass >4cm
116
Hemangioma Tx if unresectable and symptomatic
Embolization
XRT & Steroids
117
Side Effect: vinca alkaloids (vincristine/vinblastine/etc)
Ileus
118
Side Effect: Neutropenic Enterocolitis
Cytarabine
119
VIPoma
1. Watery diarrhea
2. Hypo Cl-
3. Hypo K
4. Acidosis
Location: Tail
Tx: Distal panc w/ nodes
120
Somatostatinoma
1. Mild diabetes
2. Steatorrhea
3. Gall stones
4. Hypo Cl
Location: Head
Tx: Resection, Cholecystectomy
121
prostacyclin A2 inhibitor
Inhibits platelet aggregation
122
Glucogonoma
1. Diabetes
2. Skin rash
3. Glossitis/Stomatitis
4. DVT
Location: Body & Tail
Tx: Resection
NO enucleation
123
Intrabdominal tumor in children
< 2 years: neuroblastoma
> 2 years: Wilm's tumor
124
Most common CDH
Bochdalek hernia (Posterolateral)
125
Morgagni hernia
Retrosternal CHD
126
What distinguishes GIST from leiomyoma/leiomyosarcoma
c-KIT
126
Shifts Hgb/O2 affinity to right
1) Inc body temp
2) Inc 2,3 DPG
3) Inc pCO2
4) Inc [H+]
127
Cytokine responsible for hepatic acute phase response
IL-6
128
Lidocaine toxicity
1st sx: Peri-oral paresthesias
2nd sx: Visual and auditory hallucinations
3rd sx: Cardiac arrhythmias
Tx: Atropine
129
Pancreatic enzyme secreted in active form
Lipase
130
Femoral Hernia boundary
Cooper's ligament
Inguinal ligament
Femoral vein
Passes under inguinal ligament, bulge in anteromedial thigh, reduce through inguinal ligament division, repair with McVay or Bassini repair.
131
Portal Triad
Lateral: CBD
Posterior: PV
Medial: Hepatic artery
132
Most common amino acid in tissue and plasma
Glutamine
133
Primary fuel for cancer cell
Glutamine
134
Pulmonary vital capacity
VC= FEV+FRC.
Greatest volume that can be exhaled (FEV)+ air in lungs after normal exhalation (which increased with PEEP)
135
Calcineurin Inhibitors
Inhibits lymphocyte activation (Inhibits IL-2)
Tacrolimus (FK506): Tremors, AMS, DM, HyperK, Nephrotoxicity
Cyclosporine: Gingival hyperplasia
136
Mycophenolate mofetil
Prevents proliferation (Limits purine synthesis)
GI bleed, myelosuppression
137
Azathioprine
Prevents proliferation (Limits purine synthesis)
Myelosuppresion, pancreatitis
138
Sirolimus
mTOR inhibitor
Impaired wound healing, oral ulcers
139
Belatacept
Binds CD80 and CD86
Increased risk of lymphoproliferative disordes (CNS ,PML, EVB)
140
LCIS
Prophylactic treatment vs Tamoxifen + Surveillance
If positive margins, no further resection
Endocrine therapy
141
DCIS
Lumpectomy + Radiation + Endocrine therapy
Margins: 2 mm
Mastectomy: Multicentric, multifocal, comedo type, >2.5 cm, unable to clear margins
No ALND
142
Breast: Adjuvant Chemotherapy
Node (+) Patients
High risk Node (-) Patients:
< 35 yrs
Tumor > 2cm
(-) ER/PR
Aneuploid DNA, High proliferation
Poor histology
Her2neu, p53, Ki67
143
Breast: Radiation
> 3 Lymph nodes
Skin or chest wall involvement
Positive margins
> 5 cm
Inflammatory cancer
Fixed axillary or internal mammary nodes
144
Gastric Nodes
16 nodes
145
Colon nodes
12 nodes
146
Esophageal nodes
30 nodes
147
Breast: Pregnancy
1st Trimester: MRM
2nd Trimester: Neoadjuvant Chemotherapy -> Lumpectomy -> Radiation (after delivery)
3rd Trimester: Lumpectomy, ALND, Radiation (after delivery)
148
Neuroblastoma
Surgery
Intermediate risk: Surgery + Chemo
149
Wilm's Tumor (Nephroblastoma)
Small: Surgery + Adjuvant Chemo
Downstage with Neoadj Chemo
B/l regional lymph nodes
Remove tumor when extending into vein
Gets upstaged if biopsied and bursts
150
Papillary Thyroid Ca
Low risk: Lobectomy
High risk: Total Thyroidectomy
Palpable Nodes: MRND(I-V)
151
Follicular Thyroid Ca
Lobectomy
Palpable nodes: MRND
152
Hurthle Cell Ca
Total thyroidectomy +central node dissection
Radical neck dissection on side of palpable nodes
153
Medullary Thyroid Ca
Total thyroidectomy + Centeral neck dissection
154
Jejunal Atresia: Type I
Membrane completed occludes lumen. Intestine intact
155
Jejunal Atresia: Type II
Gap between intestine with fibrous cord
156
Jejunal Atresia: Type IIIA
Mesenteric gap without any connection
157
Jejunal Atresia: Type IIIB
No SMA
Short gut
Apple peel
158
Jejunal Atresia: Type IV
Multiple atretic segments (sausage)
159
Transcystic Choledochotomy Contraindication
8 stones> / Stones >1 cm
Common hepatic duct stone
CBD <6 mm
Cystic duct <3mm
Gallstone 6-8mm
160
Insulinoma
Dx: Stomatostatin scintigraphy does not work
Tx:
Small: Enucleation
Large: Whipple, Distal pancreatectomy
161
Gastrinoma
Location: CBD/Pancreas/Duodenum
Tx: Medical therapy
Surgery for malignant (can perform hepatectomy)
