Absite Flashcards
(98 cards)
1
Q
What is the main nutrition source for colonocytes?
A
Short chain fatty acids - butyric acid
2
Q
What is the main fuel source for small bowel?
A
Glutamine
3
Q
What is the primary fuel source for neoplasticism cells?
A
Glutamine
4
Q
What are the precursors for glyconeogenesis?
A
Alanine, lactate, pyruvate, glycerol
5
Q
How does fat enter enterocyte?
A
Medium and short chains by simple diffusion
Long chain with micelle
6
Q
Where does fat go after being absorbed from GI system?
A
Long chain go to lymphatics by thoracic duct
Medium and short chain go to portal system
7
Q
What cell is the main source of histamine in blood?
A
Basophils
8
Q
What cell is the main source of histamine in tissues?
A
Mast cells
9
Q
What is the pathological cause of fever from atelectasis?
A
IL-1 released from alveolar macrophages
10
Q
Which cells produce TNF?
A
Macrophages
11
Q
Which cytokine causes fever?
A
IL-1
12
Q
What is the strength layer in bowel?
A
Submucosa
13
Q
What are the primary collagens in wound healing?
A
Type III - days 1-2
Type I - days 3-4. All type III collagen replaced by type I by 3 weeks
14
Q
Which inhaled anesthetic is best for neurosurgery?
A
Isoflurane, lowers brain O2 consumption; no increase in ICP
15
Q
Which paralytic undergoes Hoffman degradation?
A
Cisatracurium
16
Q
What do you give for an elevated R time on a TEG?
A
FFP
17
Q
What do you give for a decreased amplitude on a TEG?
A
If less than 48 mm give platelets
If 48-54 mm give desmopressin
18
Q
What do you give for decreased alpha angle on a TEG
A
Give cryo until angle is greater than 45°
19
Q
What do you give for a high LY 30 on a TEG
A
If greater than three percent give TXA
20
Q
What test confirms hyperaldosteronism?
A
Salt load suppression test, urine aldosterone will be high
21
Q
What is the aldosterone:renin ratio in hyperaldosteronism?
A
> 20
22
Q
Where is the only place in the body that makes epinephrine?
A
Adrenal medulla
23
Q
What is the treatment for unresectable adrenocortical carcinoma?
A
Mitotane
24
Q
What is the hallmark symptom of Addisonian crisis
A
Hypotension unresponsive to pressors
25
What is the treatment for nasopharyngeal squamous cell carcinoma?
XRT
26
What are the most common ectopic location for superior parathyroid glands?
Retroesophageal space, carotid sheath
27
When doing 3.5 parathyroid resection for hyperplasia which half do you respect and why?
Lateral half because artery comes in medially
28
At reoperation for missing parathyroid gland, what is most common location the missing gland is found?
Normal anatomic position
29
What is the cause of secondary hyperparathyroidism? What is the treatment?
Low Ca and high PTH due to renal failure. Ca supplementation
30
What is tertiary hyperparathyroidism and what is the treatment?
Continued high PTH after renal transplantation. Subtotal parathyroidectomy
31
What is leriche syndrome?
Buttock or thigh claudication due to lesion at aortic bifurcation or above
32
What is the cause of early <30 days failure of saphenous vein grafts?
Technical
33
What is the cause of intermediate (>30 days <2 years) failure of saphenous vein grafts?
Intimal hyperplasia
34
What is the cause of late saphenous vein graft failure (>2 years)?
Atherosclerosis
35
What is Kawasaki’s vasculitis? And what is the treatment?
Medium artery vasculitis. See aneurysm of coronaries. Tx: steroids and CABG
36
What is the most common cause of failure of AV grafts?
Venous obstruction due to intimal hyperplasia
37
What can you see on angiogram for Buerger’s disease
Cork screw collaterals with severe distal disease
38
What nerve if left undivided after vagotomy can cause persistent high acid levels?
Criminal nerve of grassi
39
Epiphrenic diverticulum is associated with what and what is the treatment?
Associated with esophageal motility disorders and treatment is diverticulectomy and myotomy
40
What is the best test for evaluating if esophageal cancer is resectable?
Ct chest and abdomen
41
What is the surgical approach for non-contained esophageal perforations?
1. Longitudinal myotomy to see full extent of injury
2. Consider intercostal muscle flaps to help cover injury
3. Drains
42
What is a primary burn caustic injury? How is it treated?
Hyperemia. Tx: observation, npo for 3-4 days, may need dilations in the future
43
What is a secondary burn caustic esophageal injury and how is it treated?
Ulcerations, educates, sloughing. Tx prolonged observation and conservative management. Esophagectomy for perforation, sepsis or pneumothorax
44
What is a tertiary caustic burn injury to the esophagus and what is the treatment?
Deep ulcers, charring, and lumen narrowing. Tx; esophagectomy
45
What is the treatment for budd Chiari syndrome?
Tips
46
What is the treatment for amebic liver abscess?
Flagyl
47
What is the treatment for hydatid cyst?
Albendazole, and surgical removal. Do not spill cyst contents, can cause anaphylaxis
48
What marker is positive in patients with fibrolamellar HCC?
Neurotransin tumor marker
49
Which extraintestinal manifestations of UC do not get better with colectomy?
Primary sclerosis cholangitis, ankylosis spondylitis
50
What is the most common site of perforation in UC?
Transverse colon
51
What’s the most common site of perforation in crohns
Distal ileum
52
What is the most common soft tissue sarcoma?
Malignant fibrous histiosarcoma
53
What is the work up for soft tissue sarcoma?
MRI to rule out vascular, neuro, and bone invasion
Excisional biopsy if <4 cm
Longitudinal biopsy if >4 cm
54
What is a dark nodule on the arm, 5-10 years after surgery and what is the treatment?
Lymphangiosarcoma, requires urgent surgery
55
What is the treatment for Paget’s disease of the breast?
Mastectomy including nipple areolar complex with snlbx
56
Why should patients with new onset ascites get diagnostic paracentesis?
Because 10-25% will have SBP
57
What lab do you not want to order on ascitic fluid?
CA-125, it is nonspecifically elevated in ascites
58
Causes of ascites with SAAG greater than 1.1
```
Cirrhosis
Hepatitis
Vascular obstructions
CHF
Metastasis to liver
Fatty liver disease of pregnancy
Myxedema
```
59
Causes of ascites with SAAG less than 1.1
```
Peritoneal carcinomatosis
Nephrotic syndrome
Pancreatitis
Peritoneal TB
Serositis
```
60
What cancer is associated with caustic esophageal injury?
SCC, 40 years later
61
When is bronchoscopy indicated for work up of esophageal cancer?
Upper 1/3 to evaluate for tracheal involvement
62
What staging studies are needed for esophageal cancer?
Ct chest/abd/pelvis
EUS for depth
Bronchoscopy for lesions in upper 1/3
63
What are the indications for screening MRI for breast cancer
Patients with lifetime risk exceeding 20-25%. Population includes strong family history of breast or ovarian cancer, BRCA + or women with first degree relative with BRCA who have not been tested, or mantle radiation for Hodgkins
64
What is the treatment for pleomorphic lobular carcinoma in situ found on core needle biopsy?
Excisional biopsy
65
Which veins are effected in Mondors disease
Lateral thoracic vein
Thoracoepigastric vein
Superficial epigastric vein
66
Does bilateral mastectomy improve survival rates in BRCA patients?
No, but reduces risk of breast cancer by 90%
67
Does bilateral oopherectomy lead to survival benefit in BRCA patients?
Yes, and it reduces risk of breast cancer by 50%
68
What are the diagnostic criteria for inflammatory breast cancer
1. Rapid onset of breast erythema, edema, or peau d’orange
2. Duration of history of no more than 6 months
3. Erythema occupying at least 1/3 of breast
4. Histological confirmation of invasive cancer
69
When should patients with FAP start screening?
Sigmoidoscopy yearly starting at 13. Surgery should be performed when florid polyposis is detected
70
What are secondary lymphoid organs?
```
Lymph nodes
Spleen
Peyers patches
Tonsils
Adenoids
```
71
What is the most common cause of portal vein thrombosis in children?
Umbilical vein infection
72
How many lymph nodes are needed for accurate staging of stomach cancer?
15
73
What lymph node dissection should be performed for gastric cancer
D1 and D2 with distal Pancreatectomy or splenectomy
74
What is intestinal gastric cancer associated with?
H pylori
75
What is diffuse gastric cancer related to?
Loss of e cadherin mutations and loss of cellular adhesion
76
When should a prophylactic thyroidectomy be performed for patients with MEN 2a? MEN 2b?
Before age 1
| By age 5
77
At what size nodule Should you consider total thyroidectomy at time omg initial surgery for concern for follicular thyroid cancer?
Greater than 4 cm. Would be a T3 lesion
78
What is Bowen’s disease and what is the treatment?
Anal intraepithial neoplasia type III.
Treatment is wide local excision with 4 quadrant biopsies to define resection region
79
What is the distance from the anal verge that you can to transanal excision?
Less than 6 cm
80
For gastric, esophageal, rectal, and colon cancer what is the T stage for a lesion that invaded the muscularis propria?
T2
81
What are the incisions and where is the anastomosis for transhiatal esophagectomy?
Cervical incision
Midline laparotomy
Cervical anastomosis
82
What are the incisions and where is the anastomosis for Ivor Lewis esophagectomy?
Midline laparotomy
Right thoracotomy
High thoracic anastomosis (above the authors vein) about 3-5 cm lower than transhiatal anastomosis
83
What are the incisions and where is the anastomosis for Mckowen esophagectomy?
Midline laparotomy
Right thoracotomy
Neck incision
Cervical anastomosis
84
What is the advantage to performing dissection through right thoracotomy in esophagectomy?
Can perform subcarinal lymphadenectomy and ligate the thoracic duct
85
What artery supplies the gastric conduit for esophagectomy?
R gastroepiploic artery
86
How do you treat a chyle leak after esophagectomy?
Adequate drainage
If output is < 500 cc/day then can treat with npo and Tpn
If output is > 500 cc/day then need to ligate duct
87
Where do you make an incision for aortic injuries?
Median sternotomy
88
What incision do you make for right subcalvian injuries?
Median sternotomy with right cervical extension
89
What incision do you make for left subclavian vessel injury?
Left anterolateral thoracotomy
90
What incision do you make for left carotid artery injury?
Median sternotomy with left neck extension
91
What are worrisome features for IPMNs?
```
Cysts < 3 cm
Thickened cyst wall
MPD size 5-9 mm
Non enhanced mural nodes
Abrupt change in MPD caliber with distal pancreatic atrophy
Lymphadenopathy
```
92
Pancreatic lesion with ovarian type stroma what is it and what is the treatment?
Mucinous cystic neoplasm
| Resection
93
What pancreatic lesion causes necrolytic migratory erythema?
Glucagonoma
94
What supplement should patients with glucagonoma receive prior to resection?
Zinc
95
Which inhaled anesthetic has the least myocardial depression
Nitric oxide
96
At what age does AFP return to normal in a new born?
9 months
97
What are the three first line medications for treatment of crohns?
Sulfasalazine
Mesalamine
Budenosine
98
How many cm are needed between strictureplasty?
At least 10 cm
