ABSITE 2024 deck Flashcards
(242 cards)
1
Q
Absolute CI and relative CI to PV embolization for hypertrophy of liver
A
overt clinical portal HTN
relative:
- PV tumor invasion
- severe coagulopathy
- uncorrected biliary obstruction/cholestasis
- renal failure
2
Q
What is preferred site for paracentesis? (if dont have US)
A
3cm medial and 3cm superior to ASIS (either side, but pick depending on surgical scars etc)
3
Q
Describe Z0011 trial
A
women>18 yrs
tumor <5cm
clinically node neg
0-2 +nodes on bx
who will receive whole breast rads after lumpectomy
no need for full ALND
4
Q
absolute CI to liver txp
A
- head bleed
- elevated intracranial pressures
- current or recent extrahep malignancy
- uncontrolled sepsis
- inadequate social/financial support
- prohibitive cardiopulm fxn including R heart strain
5
Q
Most important predictive factor for survival in RP sarcoma?
A
tuhmor resectability
followed by histologic grade
6
Q
which solid organ has the best 1 and 5 year organ specific survival rates?
A
kidney
liver is second
7
Q
Patient with TBI - best predictor of longterm outcomes?
A
motor score of POST-resuscitation GCS
8
Q
What is tx of C diff?
A
PO fidaxomicin (1st line) - 200 BID x10d
alternative 1st line: PO vanco 125 QID x10d
Bezlotuxumab - new for recurrent epi’s (given IV)
no role for IV Vanco
9
Q
is flagyl safe in pregnant women?
A
no
10
Q
utility of IABP
A
decrease afterload, improve coronary blood flow during diastoleMC
11
Q
MC indication for IABP
A
cardiogenic shock after MI
12
Q
nonspontaneous brown or cheese-like nipple discharge?
A
MC: mammary duct ectasia
13
Q
MC benign salivary gland tumors
A
pleomorphic adenoma (#1 tumor overall)
Warthin’s tumor (males)
14
Q
MC malignant salivary gland tumors
A
mucoepidermoid CA
adenoid cystic (indolent, invades nerve roots, very Sn to XRT)
15
Q
acutely bleeding gastric/esophageal varices - mgmt?
A
EGD (banding)
octreotide
abx ppx
16
Q
TBI - best predictor of longterm outcomes?
A
motor score of POST resusc GCS
17
Q
“good thing” about robot?
A
7 degrees of freedom
18
Q
what do you expect on UA for ATN (in setting of AKI)?
A
granular or epithelial cell casts
19
Q
Does hypothermia “contract” (reduce) or prolong effects of anesthetic drugs?
A
PROLONG, even with mild hypothermia
20
Q
preferred abx for pancreatic necrosis?
A
carbapenems (ie erta) preferred; flouroquinolones (CTX), flagyl
21
Q
vascular supply for -
TRAM flap
lat dorsi flap
A
sup epigastric
thoracodorsal vessels
22
Q
which structure is used to guide the perineal dissection?
A
coccyx (sweep between anus and coccyx … go laterally to ID and divide the levator ani muscles)
23
Q
what’s tx for merkel cell CA?
A
-WLE (1-2cm)
-SLNB
-Radiation if …
–primary tumor>/=1cm
–limited surgical margins
–LVI
–Head and neck primary
–Immunocompromised
24
Q
Standard endoscopes magnify images ___ and digital zoom of ___
A
30-35x
1.5-2d
25
radial scar on breast CNB - what do you do?
generally, excisional biopsy (25% malignancy)
26
pediatric varicocele (kid age <9) with no genital trauma - what's your thought?
think of a RP mass - US Abd
27
Treatment for varicoceles?
Most popular surgical: lap varicocele ligation
28
Acutely unstable patient with cardiac tamponade - best option?
pericardiocentesis
18G needle inserted to left of xiphoid
29
MC sites of embolic events in LE?
CFA
pop artery
30
what are boundaries for superficial inguinal LAD?
sartorius (lat)
aductor longus (med)
ing lig (sup)
31
what does portal triad contain
proper hepatic artery
CBD
portal vein
32
what is duration of pringle maneuver?
15-20 min at a time, unclamp 5 min
*prevent liver ischemia + abscess*
33
how to do witzel jejunostomy?
loop of jejunum 20cm from lig of Treitz --> purse string on anti-mesenteric side of jejunum --> enterotomy --> insert feeding tube + secure pigtail --> 4-6cm serosal tunnel with 3-0 silk interrupted lembert sutures perpendicular to and over the tube, prox to enterotomy site --> anchor jejunum to peritoneum with seromuscular bites prox and distally to prevent kinking
34
what is a latent error?
hidden failure of organization or system (ie EMR issue)
35
error of omission vs commission
omission: failure to provide a treatment
commission: doing something wrong (ie prescribing a med when there's a documented anaphylactic reaction)
36
patients with HIV - preop workup?
viral load w/in last 6 mo
CD4 count w/in last 12 mo
viral load = 200 --> basically no increased risk, proceed with surgery
resume meds when taking PO
for elective surgery: viral load >/= 200, and CD4 increased surgical risk; consult PCP
37
neuroblastoma (adrenals) - factors assoc with unfavorable prognosis
- age > 1 year
- N-myc amplific
- LDH
- NSE
38
appendicitis - what's psoas sign?
assoc with retrocecal appendix
RLQ pain with passive hip extension
39
what is howship-romberg sign?
obturator hernia
medial rotation of thigh --> causes pain down anteromedial thigh
can also get loss of adductor reflex (obturator nerve compression)
40
what's upper limit of LDH?
280
41
strongest prognostic indicator for melanoma?
depth
42
axillary LAD - borders?
medially: SA
lat: ant border of lat dorsi
post: subscapularis
sup: axillary vein
43
anatomical boundaries of axilla?
(diff from axillary LAD)
apex: post corder of clavicle
ant: pec major/minor
post: subscap
med: SA
lat: ant border of lat dorsi
44
define Levels I, II, III for ax LAD
Level I: lateral to pec minor
Level II: deep to pec minor
Level III: medial to pec minor
45
primary fuel for enterocytes?
glutamine
46
___ can trigger autoimmune diseases
type 1 IFNs
47
after Ladd procedure, where does cecum and duo go?
cecum in LLQ
duodenum in RUQ
48
What are Ladd's bands?
cecum to RUQ
49
Which assoc with lowest mortality?
-UTI
-resp tract infection
-CLABSI
-intra-abd
-CNS
UTI
50
MCC sepsis source
resp tract infections
40-50%
(followed by GI and GU)
51
complement proteins coalesce to form ___
MAC --> bacterial cell wall porosity + cell death
52
Type A aortic dissection assoc with extension of dissection to __
how to eval this quickly?
R coronary artery --> inferior MI
bedside TTE
53
when should you use an impella in setting of MI?
cardiogenic shock
53
first line step for anterior abd stab wound?
local wound exploration
53
what med causes tinnitus?
lasix
54
when would digoxin's side effects be emphasized?
hypoK state (competes with K ions)
55
__ can accurately differentiate between benign liver masses
MRI
56
hepatic adenoma is hyperintense on __
T2
57
1st step in lap R adrenalectomy?
mobilize R triangular ligament to mobilize right lobe of liver
(2nd step: retract liver and expose RP)
58
transanal hemorrhoidal dearterialization
Doppler guided arterial ligation with hemorrhoidopexy
-sup rectal arteries
-suture proximal to dentate line
59
pyogenic liver abscess - MC orgs?
e coli
klebsiella
60
MC presentation of DCIS?
clustered microcalcif on mammo
61
BCAA
leucine, isoleucine, valine
metabolized in muscle - good for ppl with chronic liver disease
62
what is innervation of EAS?
pudendal nerves
-inf rectal branch (S2-3)
63
acute hepatitis - serum sickness - typne of HSN?
3
64
HSN types
1: IgE (asthma, anaphylaxis)
2: cytotoxic, Ab dependent (autoimmune hemolytic anemia)
3: circulating complexes (serum sickness)
4: T cell mediated, delayed rxn (contact dermatitis, PPD)
65
indication for intra-aortic balloon pump
low cardiac output (cardiac index<2.2) or cardiogenic shock
66
splenectomy for ITP and still sx - next action?
peripheral smear
+HJ bodies = spleen still present = re-explore (not CT)
-HJ bodies = asplenia
*HJ bodies=nuclear remnants*
67
late prosthetic graft infection (>4 mo) due to __
early due to __
staph epi (late)
GP
staph aureus (early)
GP cocci, clusters
68
difference between lean process improvement vs six sigma
six sigma: reduce error/waste
lean: repeatedly revisit and fine tune; outcomes should continue to improve; value stream mapping
69
features of RP fibrosis
flank or abd pain
newly dx kidney function impairment
fibrosis can encase the aorta - if atypical features, need CT guided bx to exclude malignancy
70
early stages of wound healing - IL's?
1, 6, 8
macrophages release them
71
order of cell arrival for wound healing
platelets
neutrophils
macro's
lymphocytes
fibroblasts
72
CNB that sounds like intraductal papilloma - what next?
excisional biopsy
NOT terminal duct excision - that's if there was no identifiable lesion despite symptoms concerning for papilloma
73
amplification of __ has worst prognosis in breast cancer
HER2
74
Steps to sleeve gastrectomy
1. devasc greater curvature
2. insert bougie (34-40 Fr)
3. transect stomach starting at location 2-6 prox to pylorus
4. specimen extraction
75
what makes PID "complicated"?
TOA
pregnancy
failure of outpt mgmt
76
sarcoma - what makes up grade
mitotic activity
atypia
differentiation
presence/absence of necrosis
77
how does alvimopan work?
opioid antagonist that blocks binding to mu R
78
which HPV assoc with anal dysplasia?
HPV 16 and 18
79
accepted indic's for damage control surgery
base deficit>15
temp<34 C
pH <7.2
refractory coagulopathy
HD instability
80
what rate of bleeding can the below detect:
- angiography
- tagged RBC scan
angio: 0.5 mL/min
tagged scan: 0.1 mL/min
81
lap liver resection indicated for tumors ___ located in ___
<5cm
segments 2,3,4,5,6
82
MCC anaphylaxis?
NMB agents (roc + succ)
other:
-abx
-opioids
-hemostatic agents
-chlorhexidine
-blue dyes
-NSAIDs
83
Sx periop anaphylaxis?
Bradycardia, desat, hypotension
Difficulty ventilating
Low end tidal CO2
Rhonchi / flushing / rash / urticaria
84
Risks of brachial plexus block?
-ptx
-sx diaphragmatic palsy (due to accidental infiltration of phrenic nerve)
85
how to palliate intractable pain from PDAC?
celiac plexus neurolysis
86
Blue toe syndrome - cause and tx?
-shaggy aorta (atheromatous emboliz to LE)
-eval: CTA or MRA
-tx: supportive (hydration for kidney in case of myoglobinuria, risk reduction with ASA/statin/BP control/smoking cessation/BG control)
86
testicular torsion
chances of viability?
tx if viable after detorsion?
-just bring to OR, don't waste time with US
-highest chances in first 4-6hr
-tx: b/l orchiopexy
87
MCC met to lung
CRC
other: prostate, sarcoma
87
how long dual AP course after DES
min 6 months
88
pleural effusions caused by TB
straw colored
high protein
high LDH
89
urine Ca consistent with FHH
urinary Ca < 100mg/24 hr
Ca:Cr clearance ratio < 0.01
90
what is an endotoxin of gram neg bacteria?
LPS
91
Which meds have decreased and increased absorption after gastric bypass?
decreased:
ampicillin, cyclosporine/tacro, erythromycin, imatinib, phenytoin, tamoxifen, warfarin (though vit K absorp decr too, so actually decrease warf dose post RYGB)
increased:
atorvastatin, digoxin, lithium, PCN
92
which pancreatic enzyme secreted in active form?
lipase
(enterokinase too but that's from duo, not pancr)
93
reasons for HD?
AEIOU
acidosis, lytes, intoxication, vol overload, uremia
94
amiodarone can mess up the ___
liver
95
how long to wait to do surgery after:
- bare metal stent
- drug eluting stent
1 month
6 months
96
first signs of local anesthetic systemic toxicity?
dizziness + LH-ness
advance to seizures + respiratory depression
97
medial pec nerve innervates __
lateral pec nerve innervates __
both pec major+minor
lateral innervates only pec major
98
most common mesenteric cystic mass? and tx?
cystic lymphangioma
*mesenteric cystic mass w/ or w/o septations*
tx: complete surgical excision
99
LCIS on CNB - chance of DCIS/cancer?
10-20%
100
malignant appearing cells with fried egg appearance?
Paget cells
101
reasons for anterior midline or other atypical anal fissure?
crohns
syphylis
TB
anal cancer
HIV AIDS
102
with rectal prolapse, you have ___ rectal capacity?
decreased
103
pathophysio of duo ulcer?
H pylori (GN helical bacteria) colonization of duo mucosa that has undergone gastric metaplasia
104
operation for a Siewart type 3 tumor?
2-5cm distal to GEJ
total gastrectomy + distal esophagectomy with LAD
105
when would you consider EMR for gastric cancer?
-2cm
-well-mod diff
-no submucosal invasion (limited to mucosa)
-no LVI
106
how do you minimize paraplegia risk after AAA?
maintain adequate prograde perfusion through internal iliac's
(more common adverse outcome after TAA/TAAA than AAA)
107
hard vascular signs?
bleeding
bruit or thrill
expanding hematoma
absent pulses (decr pulse = soft sign)
distal ischemia
108
if FIBTEM MCF is abnormal, what do you give?
If MCF is low, but FIBTEM MCF is normal, what do you give?
cryo
platelets
109
for CRC anastomoses - what is primary blood flow to rectal remnant?
inf hemorrhoidal artery, from internal iliac
110
2 common causes of anastomotic leaks
staple failure
tension
111
optimal tx of neuroendocrine tumor?
- resect primary tumor
- surgical debulking of metastatic disease to <10%
- ppx chole (for octreotide therapy later)
112
primary tx of hyperCa
NS resuscitation goal UOP >100/hr
(avoid LR)
113
tx for aldosteronoma?
optimize medically 1st (spironolactone for HTN, low K)
then unilat resection
114
cyanide poisoning - talk to me
cyanide comes from fire exposure and smoke inhalation
inhibits oxidative phosphorylation by binding to cytochrome C oxidase, blocking MTC
115
afib in setting of EF<35 - tx?
avoid CCB or BB
instead give amio
116
Gardner syndrome - 3 things it's assoc with?
epidermal cysts
GI polyposis
osteomas
117
MC met to adrenal?
lung
118
MC vitamin deficiency post-bariatric surgery?
vit D (absorbed in small bowel)
119
cyclical mastodynia - tx?
rule out malignancy FIRST
1st: conservative mgmt (well fitting sports bra, topical/oral NSAIDs, avoid caffeine)
2nd: SERM (max 6 months)
3rd: danazol
4th: bromocriptine
120
what is intraop hypothermia assoc with?
- wound infxns
- slower clearance of anesthesia
- worse pain
- coagulopathy
(random: protection against cerebral ischemia)
121
when is RA iodine rec after thyroid surgery?
*tumor>4cm
*ETE
*postop unstimulated thyroglobulin >5-10
*bulky or >5 +LN
122
w/u of solid testicular mass?
*US
*tumor markers (AFP, b-HCG, LDH)
*staging CT A/P + CXR
*MRI Brain only if suspicious for brain mets
123
what is a coloplasty?
longitudinal colotomy (antimesenteric side) closed transversely
-use when narrow pelvis or not enough colonic mobility for a J pouch
-increases reservoir capacity after resection for rectal cancer
124
duo switch - briefly, what is it?
sleeve + bypass, with short common channel (100cm)
125
what is rigler triad?
pneumobilia
SBO
ectopic calcified gallstone on imaging
126
what is assoc with high ICP?
Cushing triad (HTN, bradycardia, resp depression)
CN 6 palsy
127
Incidental meckel's mgmt
all kids 2cm, palpable abnormality or assoc fibrous band
adults >49: resect if palpable abnormality
128
5 year survival after liver transplant for HCC (if follow milan criteria)
65-90%
129
talk to me about gastric lymphomas
-non Hodgkin's (DLBCL 55% > MALT lymphoma 40% > Burkitt 3%)
-over 50% present w anemia
-sx: early satiety, bloating
-dx: EGD + bx
-tx: CHOP
130
Types of prevention:
primordial
primary
secondary
tertiary
quaternary
primordial: RF reduction for popul using laws/policy
1: prevent occurrence of ds (immuniz)
2: detect subclinical ds to prevent progression (Cscope, pap smear)
3: reduce severity of ds once already present (rehab)
4: reduce interventions that could actually cause more harm than good (pt's with unexplained psych sx)
131
Merkel cell carcinoma - tx?
WLE, SLNB +/- usually adjuvant radiation if concerning features (>1cm, +LVI, etc)
1-2mm margins to investing fascia
132
supracondylar fx of humerus - fix? possible complic?
closed reduction + perc pinning (in kids)
Volkmann's ischemic contracture - splint in flexion and kink neurovasc structures (brachial artery) --> cmpt syndrome --> permanent withered hand
133
what's most definitive mgmt of pancreatic duct injury?
ERCP (stent I'm assuming)
134
side effects of sirolimus?
anemia
thrombocytopenia
HLD
135
difference bw tacro and cyclosporine
tacro: diabetogenic, alopecia
cyclosporine: hirsutism, gingival hyperplasia
136
imaging modality of choice for adrenal mass
thin cut multiphase CT
137
when use endorectal US for CRC cancer?
mid-low rectal cancers below anterior peritoneal reflection
138
TNF alpha increases __ and __
catabolism and insulin resistance
139
how does vanco work
block cell wall synthesis
140
CCA - most common morphology, most favorable histology?
sclerosing or periductal
papillary
141
when would rib plating be useful?
>5 fx
b/l rib fx
flail segment
*can reduce ICU LOS and ventilator days (if impaired respi mechanics)
142
protein C deactivates factors __ and ___
Va and VIIIa
143
what are major RF for postop respiratory complications?
operative time >2.5 hrs
>>> ASA class > 3
>>> preop anemia
>>> advanced age
144
painless hematuria + weight loss --> best imaging study?
CT A/P (not US)
145
enteroccocus
best first line tx for normal enterococcus or VRE?
GP, anaerobic cocci
Unasyn
146
surveillance for watch and wait (rectal cancer)
every 2-3 months, for 3 yrs:
- DRE
- proctoscopy
- MRI
- CEA
147
tx for symptomatic or >7cm desmoids?
WLE with frozen section
148
tx for SBP
cefotaxime + albumin
149
Frailty Score - is 1 very frail or fit?
1 = most fit
150
value stream mapping ___
cannot identify errors in the medical care system
it is a visual map to help lean processes and make them more efficient
151
Six sigma __
identifies and correct root causes of variation
152
what is urine in pyloric stenosis?
urine ph LOW (excrete H for Na)
Urine Na LOW (reabsorbing Na)
urine K HIGH (excrete K to preserve Na)
153
cyanosis + low O2 sat - suspect?
metHgb-emia
methylene blue
154
Bites - which bugs to think of?
pasteurella
human: eikenella
abx: augmentin
PCN allergy: clinda + cipro (or bactrim if pregnant/child)
155
general TPN req's
*25-50% carbs
*30% fats? (10-20% lipid infusion...) - aim for 2.5 g/kg/d
*protein: 1.5 g/kg/d (less for hepatic failure or renal failure not on dialysis)
*water: 30 cc/kg/d
156
describe c diff
GP anaerobic bacilli
toxin a = enterotoxin
toxin b = cytotoxin (intestinal mucosal inflammation)
157
highest RF for post op mortality after CABG?
prior heart surgery
158
what's other word for Mann Whitney U test?
Wilcoxon rank-sum test
159
what is TEP
total extraperitoneal
160
what is TAPP
transabd pre peritoneal
161
162
what makes an EC fistula more likely to close?
tract >2cm
smaller defect size
low output (<200/day)
acute etiology (ie - appendicitis, diverticulitis)
no sepsis
well nourished
163
what is qSOFA score
GCS<15
RR>21
SBP<99
164
what is purpose of preoperative exam?
identify, quantify, and modify any risk factors
165
primary source of bilirubin?
senescent RBCs
166
tx for gonorrhea?
CTX
167
tx for chlamydia?
doxycycline
168
what can nitroprusside lead to?
cyanide toxicity
-weakness
-confusion
-pulm edema
thiocyanate>200 --> life threatening
tx: sodium nitrate
169
antidotes to cyanide toxicity?
sodium nitrite
sodium thiosulfate (this and above usually together)
hydroxocobalamin (1st line)
amyl nitrite (lots of side effects)
170
tx for spherocytosis?
splenectomy + chole
wait till after age 5
171
entereg - contraindic?
therapeutic opioid use >7 days
incr risk of MI and GI side effects
172
what's metabolic derangement in primary hyperPTH?
hyperchloremic metab acidosis
173
what does vit C def prevent?
proline hydroxylation (weaker collagen)
174
MC composition of kidney stone?
Ca oxalate
175
false + rate of PET for cutaneous melanoma? (for mediastinal malig)
10-20%
176
pelvic hemorrhage with negative FAST - what are your 3 options?
1. IR
2. preperitoneal packing
3. REBOA into zone 3
177
Lymphangitis
MC org: strep pyogenes
2nd MC: staph aureus
tx: keflex, ancef, CTX
PCN allergy: clinda, bactrim
178
Abx for OPSI
IV Vanco and CTX (or cefotaxime)
179
chylothorax mgmt for:
< 1 L
> 1L
Less than 1L:
conserv mgmt x2 wks - drain, octreotide, low fat diet/TPN
Greater than 1L or failure of med mgmt:
Thoracic duct ligation or embolization
180
person on PD with watery diarrhea and peritonitis - thoughts?
bowel wall erosion (dialysate leaking into bowel)
peritonitis? tx: ex lap
181
pt with adrenal insufficiency who's in hospital, hypotensive - what do you do?
dexamethasone --> corticotropin (ACTH) stimulation test + measure basal ACTH --> if low ACTH, low cortisol, then have your dx
change to hydrocortisone + fludrocortisone
182
Imaging for CCA
contrast enhanced MRI
or multiphasic CT
start with EUS guided FNA (esp for distal lesions), but can also do ERCP with brushings (esp if concern for biliary obstruction and need stent placement too)
183
"bent inner tube"
volvulus
(coffee bean seems to be sigmoid, usually)
184
double bubble
duo atresia
185
high RF for basal cell
>2cm
immunocompromised
poorly defined
recurrent
186
what's a normal phi angle?
<60 degrees
187
histology of thyroid pathologies
*papillary: pale cytoplasm, large crowded nuclei, intranuclear cytoplasmic inclusions
*medullary: sheets of infiltrating heterogeneous neoplastic cells
*Hurthle: hypercellular, eosinophilic cells
*follicular: solid sheets of cells with no colloid
188
desmoid - pos and neg for?
+vimentin, B-catenin, actin
-cytokeratin, S100
189
how to tx SBP in a nonseptic patient?
intraperitoneal abx
GP coverage: ancef or vanco
GN coverage: 3/4th gen cephalosporin or aztreonam or aminoglycoside (-micin)
190
MCC pyogenic liver abscesses
portal vein seeding from
- bowel leakage
- biliary infection
191
what are degs of hypothermia?
90-94
84-89
<84
192
which med during resuscitation after cardiac arrest can cause seizures?
sodium bicarb (hyperosmolar/hyperNa state)
193
efferent loop syndrome
kinking of jejunal limb usually 2/2 herniation posterior to anastomosis
194
GERD - what is an alarm symptom?
dysphagia
early satiety, continued pain, odynophagia (pain w swallowing)
195
MC location of mets from
- extremity sarcoma?
-RP sarcoma?
lung
high grade = greater risk of mets
RP sarcomas tend to mets more locoregionally
196
tx for choledochocele (type III choledochal cyst)?
ERCP w sphincterotomy
CCA risk is too low to warrant morbidity of surgery
197
seatbelt sign / diffuse abd pain + free intraperitoneal fluid (blood) + lumbar vertebra fx
no signs of solid organ injury or free air
what do you do?
ex lap - small bowel injury
short delays increase M&M of SB injuries significantly
198
VHR - recurrence rate with and w/o mesh?
primary open tissue repair: 30-60%
w/ mesh: 10%
199
Tumor markers with:
yolk sac tumor
germ cell tumor
epithelial & sex cord stromal tumors
epithelial ovarian
yolk sac : AFP
germ cell : bHCG
epithelial & sex cord stromal : inhibin
epithelial ovarian : CA 125
200
large (>1.5-2cm), especially sessile polyps - how remove?
piecemeal
sessile - try to use EMR, lift submucosa up
201
is succ depolarizing or NON depolarizing?
-depolarizing
... so it can result in fasciculations
-nicotinic activation --> can result in bradycardia (via muscarinic stimulation)
-it is metab by plasma pseduocholinesterase
202
MC site of supernumerary PTH gland? 2nd MC site?
thymus
2nd MC: mediastinum
203
which c diff toxin causes intestinal necrosis?
toxin A
204
OR for testicular torsion - what kind of incision?
midline scrotal
205
appendiceal cancer - when ok to do a simple appy?
appendiceal mucinous neoplasm or NET that is:
<2cm
unruptured
does not involve base
If mucinous adenoCA or worse than above - R hemi
206
aortic valve - indic for repair / replacement?
valve area < 1 cm sqd
207
PPI - moa?
IRREV inhibition of H/K ATPase
(parietal cells)
208
ICA stenosis
<50%
50-69%
>70%
PSV &. ICA:CCA PSV ratio
<125 ... <2
125-230 ... 2-4
>230 ... >4
209
underlying pathology of post vagotomy dysphagia?
periesophageal fibrosis and lower esophageal denervation (from stripping)
210
ortho + GI surgery -- good indicator for 30 day mortality?
albumin
211
30 day mortality for EVAR v open AAA repair
1-2% vs 4-5%
212
operation for SMA syndrome?
duodenojejunostomy
212
BRCA 1 or 2 mutated + triple neg cancer = which special therapy?
olaparib (PARP inhibitor)
212
pediatric blunt abdominal trauma - MC hollow viscous injury?
jejunum
then ileum I think
213
ideal preop diet for bariatric pt?
low carb, high protein, low calorie
(some wt loss, reduce fatty liver)
214
how to access intrathoracic trachea?
R posterolat thoracotomy
215
what can tracheal injury result in?
mediastinitis (drainage of secretions into mediastinum)
stenosis if injury is missed
216
how far must tumor be from CP to do esophagectomy?
>5cm
217
MCC late access issues with AVF
intimal hyperplasia at graft-VENOUS anastomosis (later resulting in thrombosis)
218
indic for adjuvant RADIATION for extremity sarcoma
>5cm
high grade
close margins
219
tx of cardiac failure from AVF
med mgmt --> AVF banding --> if that fails, then ligation
220
wtf is orlistat?
reversibly inhibits pancreatic & gastric lipases (weight loss med)
221
Indics for resection of rectal carcinoid?
>2cm
T2 (musc propria) or higher
LVI
high mitotic rate
222
MCC mortality after blood transfusion
TRALI
223
treatment of gynecomastia?
liposuction of adipose and surgical excision of glandular tissue
224
FAP s/p TAC + ileorectal mosis - surveillance?
lower endoscopy annually
upper endoscopy every ?1-3 yrs
225
timing of preop ppx abx?
1 hr of incision
226
tx for resectable CRLM
resection + adj 6 mo chemo
227
macrolides + renal insufficiency
QT prolongation
228
MC genetic defect in CRC
APC - chrom 5
229
presence of everted anal crypts = ?
rectal intussusception
230
what is peripheral femoral nerve palsy
inject local in wrong spot
inability to extend knee
231
pelvic fx with bleeding in bay .. mgmt?
unstable:
temp responder:
stable:
unstable: ex fix and preperitoneal packing
temp responder: IR
stable: CT
232
Absolute CI to thrombolysis
active internal bleeding
known intracranial neoplasm
recent trauma, CVA, intra-cranial/spinal surgery (2 mo)
severe uncontrollable HTN
uncontrolled clotting disorder
233
cystic artery comes off RHA and originates __ to common hepatic duct
POSTERIOR
234
how to reverse tpa?
cryo
if not available - aminocaproic acid (binds lysine residues)
235
protamine dose?
1-1.5mg for every 100u heparin
give slow - risk hypotension
236
tx for lymphangiocarcoma (Stewart Treves)
total mastectomy with or without SLNB. Adjuvent chemo
