Absite book Flashcards
(265 cards)
1
Q
MC anaerobe and aerobe for colon cancer
A
anaerobes- bacteroides
aerobes- e coli
2
Q
E coli toxin
A
endotoxin
LPS lipid A
triggers TNF alpha release
3
Q
SSI risk by surg class
A
Clean 2%
Clean contaminated 3-5%
Contaminated 5-10%
Gross contaminated 30%
4
Q
biofilm
A
from staph
exopolysaccharide matrix
5
Q
what if bacteroides grows from SSI?
A
necrosis or abscess (anaerobe)
implies translocation from gut
6
Q
MC postop infection –> death, also MC organism
A
pneumonia
staph aureus #1 in ICU (pseudomonas #2)
7
Q
Line infection organisms
A
1 staph epidermidis #2 staph aureus
8
Q
Endo v exotoxin
A
E coli has endotoxin
GAS exotoxin
9
Q
cperfringens toxin
A
alpha toxin
10
Q
aspergillosis tx
A
voriconazole
11
Q
SBP bug, protein, wbc, tx
A
low protein, ecoli (strep 2, kleb 3), PMN >500, ceftriaxone
12
Q
beta lactams- drugs and MOA
A
pcn, cephalosporins, carbapenems, vanco
inhibit cell wall synthesis
13
Q
30s ribosomal inhibitors
A
tetracyclines
aminoglycosides (-micins)
linezolid
14
Q
50s ribosomal inhibitors
A
clindamycin
azithromycin (macrolides)
15
Q
fluoroquinolone moa
A
inhibit DNA helicase
16
Q
rifampin moa
A
inhibits rna polymerase
17
Q
peak vs trough dosing
A
peak too high- decrease amount of each dose
trough too high- decrease frequency
18
Q
Nutrition recs daily by type
A
20% protein (4cal/g) (1g/kg/day)
30% fat (9cal/g)
50% carb (4cal/g)
19
Q
burns nutrition recs
A
25cal/kg + (30cal x %tbsa)
protein 1 + (3g x %tbsa)
20
Q
albumin v prealbumin half life
A
18 days albumin
2 days prealbumin
21
Q
Resp Quotient?
A
CO2 produced to O2 consumed
RQ>1 = too much feed
RQ<0.7 = ketosis and fat oxidation
22
Q
Refeeding syndrome- electrolyte imbalances
A
decreased K, Mg, PO4
23
Q
wound healing steps
A
inflamm 1-10d (epithelialization at 1-2mm/day)
proliferation- 5d-3wks (collagen deposition, neovascularization, granulation tissue formation, type III collagen –> type I)
remodeling- 3wk-1yr (collagen cross-linking, but no further collagen production)
24
Q
wound healing cell type by day?
A
Day 0-2 PMN
Day 3-4 macrophages (release growth factors and shit for healing)
Day 5 + fibroblasts
25
open vs closed incision healing
open- epithelial integrity, dependent on granulation tissue
| closed- tensile strength, dependent on collagen deposition and cross linking
26
when does wound reach max strength?
8 weeks (80% original strength)
27
aortic arch anatomy
innominate (becomes right subclav and right common carotid)
left common carotid
left subclav
28
aortic aneurysm repair indications
ascending: >5.5 or >0.5/yr
descending: >5.5 can do endovascular repair, >6.0 open
29
aortic dissection classifications
stanford:
Class A- any ascending
Class B- descending only
DeBakey:
Type I- ascending and descending
Type II- ascending only
Type III- descending only
30
usual causes of death (3) in aortic dissection?
aortic insufficiency --> cardiac failure
cardiac tamponade
rupture
31
indications for aortic dissection repair
```
all ascending (open repair only)
descending if with visceral/extremity ischemia or if contained rupture (endograft is option)
```
32
artery of adamkiewicz
comes of anterior spinal artery ~T9
| can be injured during descending thoracic aortic surgery --> paraplegia
33
what divides ascending and descending aortic dissections?
left subclavian
34
sidedness of liver abscesses
amebic, echinococcus, pyogenic usu in right lobe
35
amebic liver abscess pathophys
colonic infection --> liver via portal vein
36
amebic liver abscess workup and management
CT usu, culture will be sterile
| flagyl
37
echinococcus workup and management
casoni skin test
CT shows ectocyst (calcified), endocyst (double walled cyst)
perform pre-op ERCP if elevated LFT/bili/cholangitis (check for biliary communication)
albendazole x2 weeks, then surgical removal
38
schistosomiasis tx
praziquantel for liver abscess
| can cause variceal bleeding
39
pyogenic abscess dx and amangement
```
dx aspirate (usu e coli)
drain and abx
```
40
FAP gene and inheritance
APC (chromo 5)
| auto dom
41
FAP management
prophylactic colectomy at 20
endoscopy q2 yrs for duodenal polyps
lifetime rectal surveillance
42
Gardner v Turcot
both colon CA, APC gene
gardner- desmoid tumors/osteomas
Turcot- brain tumors
43
lynch syndrome gene and inheritance
auto dom
| DNA MMR gene
44
lynch I vs II
I- colon CA only
| II- also ovarian, endometrial, bladder, stomach
45
Amsterdam criteria for lynch syndrome
3,2,1
3 first degree relatives
2 generations
1 with cancer before 50
46
lynch syndrome management
surveillance colonoscopy at 25 or earlier (10yrs before first primary relative)
do total colectomy at first cancer sx
47
MC cancer and cancer deaths?
women breast
women lung death
men prostate
men lung death
48
CEA/AFP/CA19-9/CA 125
CEA- colon CA
AFP- liver CA
CA 19-9- pancreatic CA
CA 125- ovarian CA
49
```
Tumor markers:
beta HCG?
NSE?
chromagranin A?
Ret oncogene?
```
bHCG- testicular CA, choriocarcinoma
NSE- small cell lung CA, neuroblastoma
Chromagranin A- carcinoid
ret oncogene- thyroid medullary CA
50
EBV associated malignancy
nasopharyngeal CA
| burkitts lymphoma
51
```
side effects:
cisplatin
carboplatin
vincristine
vinblastine
```
cisplatin- nephro, neuro, ototoxic
carBoplatin- Bone myelosuppression
vincristine- peripheral neuropathy
vinBlastine- Bone myelosuppression
52
cyclophosphamide side effects
```
hemorrhagic cystitis (can be helped with mesna)
SIADH
gonadal dysfunction
```
53
sweets syndrome
acute febrile neutropenic dermatitis
| side effect of GCSF admin (used for neutrophil recovery after chemo)
54
Li Fraumeni syndrome- gene and cancers
p53
| sarcomas, breast CA, brain, leukemia, adrenal CA
55
suspicious axillary node- primary? top3
lymphoma #1
breast
melanoma
56
krukenberg tumor
ovarian tumor (met from stomach)
57
bony mets- MC primaries?
breast and prostate
58
small bowel mets- MC primary?
melanoma
59
induction v neoadjuvant v adjuvant v salvage chemo?
induction- chemo only
neoadjuvant- chemo first
adjuvant- chemo later
salvage- when initial chemo doesnt work
60
empyema phases
```
exudative phase (1 wk)- chest tube and abx
fibroproliferative phase (wk 2)- CT and abx, maybe VATS
organized phase (wk 3)- decortication
```
61
normal aorta size (Abdom)
2-3cm
62
cause of AAA
degen of medial layer
63
AAA rupture- most likely to rupture where?
left posterolateral wall, 2-4cm below renals
64
when to reimplant IMA with AAA repair?
if backpressure <40
prior colonic surgery
stenosis at SMA
inadequate flow to colon
65
#1 cause of death after AAA repair (early and late)?
early- MI
| late- renal failure
66
complications of AAA repair
impotence (make sure at least one internal iliac has good flow)
MI, renal failure (#1 cause of death, early and late)
graft infection 1%
pseudoaneurysm 1%
atherosclerotic occlusion (MC late complication)
left colon ischemia (bloody diarrhea)
67
Criteria for EVAR
```
neck length >15mm
neck diam 20-30mm
common iliac length >10mm
common iliac daim 8-18mm
neck angle <60deg
no calcs, no neck thrombus
```
68
endoleak type
type I- at attachment sites
type II- collaterals bleeding (observe)
type III- at overlap sites (if using multiple grafts or if graft tears)
type IV- porous graft wall (observe)
69
inflammatory AAA
not infection
10% of AAA
can get adhesions to duodenum, and ureters
thickened rim on CT
70
mycotic (AAA) aneurysm- bugs, tx
salmonella (#1), staph
infection of atherosclerotic plaque
bypass and resection of infected aorta
71
aortic graft infection bugs and tx
staph #1, e coli #2
| bypass and resect infected graft
72
aortoenteric fistula- presentation, location, management
>6mo after surgery (AAA repair)
hematemesis, then blood per rectum
erosion into 3rd/4th portion of duodenum
bypass, resect graft, close duodenal hole
73
conjoined tendon
transversalis and internal oblique
74
Basssini repair
conjoined tendon to inguinal
75
howship romberg
inner thigh pain with internal rotation
| obturator hernia sign
76
desmoid tumor syndromw?
gardners (+colon ca)
77
mesenteric tumors- benign v malignant location, type of malignant common?
benign- more peripheral
malignant- closer to root
usu liposarcoma, leiomyosarcoma
78
RP tumors MC type?
lymphoma #1
| liposarcoma #2
79
CO2 embolus tx
head down
turn to left
aspirate CO2 through central line
80
basal cell appearance and path
pearly, rolled borders
| peripheral palisading nuclei, stromal reaction
81
basal cell treatment
0.3-0.5cm margins
| xrt and chemo
82
squamous cell skin cancer
0.5-1.0cm margins
Mohs sx for high risk
xrt chemo
83
which pain med to avoid in pancreatitis?
morphine
| can cause sphincter of oddi contraction
84
indications for cystgastrostomy in pancreatic pseudocyst
no resolution with conservative management (3mo?)
| growing (maybe resect to r/o cancer)
85
med for pancreatic fistula or pleural effusion/ascites 2/2 pancreatitis
octreotide (decreases secretions)
86
dx of chronic pancreatitis
CT- shrunken pancreas, calcs
ERCP
chain of lakes on imaging
87
Puestow v frey procedure indicaton
puestow- pancreatic duct >8mm
| frey- core out if narrow duct
88
MC cause of splenic vein thrombosis, and tx?
```
chronic pancreatitis (can cause gastric varices)
tx splenectomy
```
89
dx pancreatic insufficiency
fecal fat testing
90
peritoneovenous shunts- indications and contraindications
refractory ascites with venous anatomy that precludes TIPS
| contraindicated in liver transplant candidates
91
mc gallbladder ca met?
liver (IV and V)
92
gallbladder ca tx
no muscle involved - chole
muscle involved- wedge resectionof seg IVb and V
tumor can implant to trocar sites
93
improved extracolonic symptoms after proctocolectomy in UC
erythema nodosum
uveitis
arthritis
94
papillary thyroid cancer pathology
psammoma bodies
| orphan annie nuclei
95
papillary thyroid cancer managemetn
<1cm- lobectomy
>1cm, bilateral lesions, hx of XRT- total thyroidectomy
need radioactive iodine if residual dz
96
spread of thyroid cancers
follicular- hematogenous (MC to bone)
| papillary and medullary- lymphatic
97
follicular thyroid cancer managemetn
lobectomy (dx)
if cancer >1cm, need total thyroidectomy
radioiodine if >1cm or extrathyroidal dz
98
medullary thyroid cancer pathology
parafolicular c cells (secrete calcitonin)
| amyloid deposition
99
medullary thyroid cancer- presentation
usually diarrhea (secrete calcitonin --> flushing and diarrhea
100
prophylactic throidectomy for men2a vs men2b
2a- at 6yo
| 2b- at 2yo
101
radioactive iodine therapy
4-6wks after thyroidectomy
| for follicular and papillary only
102
thoraic outlet anatomy
subclavian vein between clavicle and first rib, anterior to anterior scalene
subclavian artery and brachial plexus posterior to anterior scalene
103
symptoms of thoracic outlet syndrome
neuro mc (usu ulnar distribution)
tinsels test
venous: effort induced thrombosis (paget von schrotter), give thrombolytics and resect rib
arterial: usu d/t anterior scalene hypertroph, ischemia, adsons test, resection or bypass
104
CA19-9
| CA125
CA19-9 pancreatic cancer
| CA125 ovarian CA
105
beta HCG
testicular CA and choriocarcioma
106
NSE tumor marker
small cell lung CA
| neuroblastoma
107
chromagranin A
carcinoid tumor
108
cisplatin and carboplatin side effects
cisplatin- nephrotoxic, neurotoxic, ototoxic
| carboplatin- Bone (myelo)suppresion
109
vincristine and vinblastine side effect
```
vincristine peripheral neuropathies
vinblastine bone (myelo)suppression
```
110
cyclophosphamide side effect
```
SIADH
hemorrhagic cystitis (give mesna to help alleviate)
```
111
Rb1, p53, APC, DCC
```
all tumor suppressors
Rb1 Chr13
p53 chr 17
APC chr 5
DCC chr18
```
112
Li Fraumeni
p53 defect
| sarcomas, breast CA, brain tumors, leukemia, adrenal CA
113
krukenburg tumor
stomach tumor or colon tumor (from ovarian mets)
114
Phase I, II, III, IV
Phase I: safe and at what dose
Phase II: effective?
Phase III: controlled trial
Phase IV: implement and marketing
115
prognostic indicators for hepatic colorectal mets
```
disease free interval >12mo
tumor # <3
CEA <200
size <5cm
negative nodes
```
116
primary mortality periop kidney transplant
MI and stroke
117
kidney rejection workup and management
duplex ultrasound
biopsy
decrease CSK and FK (these can be nephrotoxic)
pulse steroids
118
MELD score
liver transplant vs medical therapy (if >15, transplatn is better)
involves creatinine, INR, bilirubin
119
liver transplant for hep B, how to prevent reinfection?
HBIG and lamivudine (reduces reinfection rate by 20%)
120
acute vs chronic rejection of liver transplant
acute- first 1-2 months, portal triad lymphocytosis, endotheliitis, bile duct injury (t cell mediated0
chronic (rare)- disappearing bile ducts
121
What does KP transplant fix (and not fix)
decreases retinopathy and neuropathy
decreases autonomic dysfunction (gastroparesis)
Does NOT reverse vascular disease
122
#1 cuase of early mortality for lung transplant
reperfursion injury (similar to ARDS)
123
path for heart or lung acute rejection
perivascular lymphocytosis
124
MCC cuase of late mortality for lung transplant
```
briochiolitis obliterans (chronic rjeectION)
MC cause of death overall
```
125
trauma hemorrhage- BP when decomp and fluid resus
BP ok until 30% body volume loss
| 2L LR , then give blood
126
DPL positive criteria
>10cc blood, >100,000 RBC/cc, food, bile, bacteria, >500wbc/cc
127
DPL misses?
RP bleeds
| contained hematomas
128
ER thoracotomy indications
Blunt- if pressure lost in ER
| penetrating- if pressure lost on the way to ED
129
ED thoracotomy incisions
right fourth and fitfth intercostal spaces
clamp descending thoracic aorta (if abdom injury)
open pericardium anterior to phrenic nerve in longitiudinal fashion
130
decreasing ICP
```
raise HOB
sedation/paralysis
relative hyperventilation (CO2 30-35)
hypertonic saline (Na 140-150)
mannitol
```
131
C1 and C2 named fractures and management
```
C1 burst (jefferson)- axial loading (rigid collar)
C2 hangmans (bilateral pedicles)- traction and halo
C2 odontoid- above base = stable, at base (will need fusion and halo), extension into vetebral body (will need fusion and halo)
```
132
epistaxis management
anterior packing
| pstieror- may need to embolize internal maxillary artery
133
neck zone borders
Zones I- clavicle to cricoid cartilage
| zone II- to angle of mandible
134
management of esophageal neck injuries
```
small- primary clsoure
big neck- place drains
big chest- spit fistula and then esophagectomy later
Neck- left side
upper 2/3 thoracic- right thoracotomy
lower 1/3 thoracic- left thoracotomy
```
135
chest tube indications for thoracotomy
>1500cc at insertion
>250cc/hr for 3 hrs
>2500cc/24 hrs
136
diaphragmatic injuries- repair approach
transabdominal if <1 week
| thoracic if >1 week (will need to take down adhesions)
137
aortic injuries and appropriate incision/approaches
median sternotomy- ascending aorta, innominate, proximal right subclav, proxima left common carotid
left thoracotomy- left subclavian, descending aorta
midclavicular incision with clavicular resection- distal right subclavian
138
penetrating box injury
clavicles/xiphoid/nipples
| need pericardial window, bronchoscopy, esophagogoscopy , barium swallow
139
management of paraduodenal hematomas
usu in third portion
if intraop >2cm, open
if found on CT- TPN and NGT, usu cure within 2-3 wks
140
management of duodenal injury
try for primary repair
if not, jejunal serosal patch
if not, pyloric exclusion or gastrojejunostomy
distal feeding J and proximal draining J
141
conservative management failure for liver and splenic injury?
hypotension or hct <25 after 4 units pRBC for liver, 2units pRBC for spleen
142
hematuria after trauma?
get CT scan and IVP if you can
143
extraperitoneal vs intraperitoneal bladder rupture
extraperitoneal- just leave foley in for 1-2 weeks
| intraperitoneal- need repair
144
urethral tear management
large tear- suprpubic cystostomy and repair in 2-3 months
| small tear- urethral catheter and repair in 2-3 months
145
kleihauer betke test
test for fetal blood in maternal circulation (placental disruption)
146
pressure sore stages
I- erythema only
II- partial skin loss
III full thickness (subQ fat)
IV- involves bone and muscle
147
types of melanoma
lentigo maligna- least aggressive
superficial spreading- MC
nodular- most aggressive
acral lentiginous- aggressive, african american, soles/palms
148
melanoma thickness and resection margins
```
<1mm = 1cm margins
1-2mm = 1-2cm margins
>2mm = 2cm margins
```
149
management of anteiror neck and head melanoma
if >1mm - need to do superficial parotidectomy
150
soft tissue sarcoma staging based on?
grade (not sz)
151
recurrent laryngeal nerve innervates?
larynx (except circothyroid muscle)
| superior laryngeal innervates cricothyroid
152
larynx inervation?
recurrent laryngeal most
| cricothyroid is innervated by superior laryngeal
153
thyrocervical trunk branches
```
STAT
suprascapular
transverse cervical
ascending cervical
inferior thyroid
```
154
trapezius flap artery?
transverse cervical
155
most common site of oral cavity cancer?
lower lip (sun exposure)
156
plummer vinson syndrome
glossitis, esophageal web, spoon fingers, IDA
157
naspharyngeal, oropharyngeal, hypopharyngeal SCCA --> nodes?
naso and oro --> posterior cervical
| hypopharyngeal --> anterior nodes
158
nasopharyngeal, oropharyngeal, hypopharyngeal SCCA- management?
naso- XRT only
| oro and hypo- XRT if <4cm and no nodes, otherwise XRT + surgery
159
parotid surgery - injured nerve?
greater auricular nerve (numb to lower ear)
160
MC salivary gland tumor in kiddos?
hemangiomas
161
csf rhinorrhea indicative of?
cribriform plate fx
162
peritonsilar abscess vs retropharyngeal abscess vs parapharyngeal abscess?
peritonsillar in older kids >10yo
retropharyngeal <10yo, airway emergency
parapharyngeal- dental infections, morbiditiy from mediastinal spread, drain through lateral neck and leave drain
163
ludwigs angina- involved muscle?
mylohyoid
| usu 2/2 dental ifnection
164
preauricular tumor- most common?
parotid
usually benign
mc benign is pelomorphic adenoma
165
head and neck mets to ?
lung
166
posterior neck mass is what?
lymphom until proven otherwise
| get FNA
167
neck mass workup-
laryngoscopy and FNA (maybe do abx x2wk trial)
panendoscopy and neck/chest CT
excisional bx
168
benefits of tracheostomy
decreased secretions
easier ventilation
decreased pna risk
169
cleft lip v cleft palate management
cleft lip- repair at 10wks/10lb/10hgb
| cleft palate- repaire at 12mo
170
anterior vs posterior pituitary
anterior- ACTH, TSH, GH, LH, FSH
| posterior- ADH, oxytocin
171
med to give for pituitary tumor?
bromocriptine (dopamine agonist0)
172
acromegaly 2/2 pituitary adenoma- dx, management and mc complication
elevated IGF1
octreotide and resection
worry about cardiac symptoms
173
nelsons syndrome
```
after bilateral adrenalectomy
increased CRH --> pituitary enlargement
causes amenorrhea and bitemp hemianopia
hyperpigmentation
give steroids
```
174
sheehans vs waterhouse friedrichsen
sheehands- post preg, pituitary ischemia
waterhouse- adrenal gland hemorrhage post meningicoccus infection
both cause adrenal insufficiency
175
adrenal vasculature-
```
superior adrenal (inferior phrenic)
middle adrenal (aorta)
inferior adrenal (renal)
```
176
incidentaloma-management
urine metanephrines, urine hydroxycorticosteroids, renin/aldosterone levels
Surgery needed if >4cm, nonhomogenous or >10% functioning, <60% washout, enlarging
otherwise follow
also need bx if any cancer history
177
common primary that mets to adrenal?
lung CA #1
| breast, melanoma, renal ca
178
adrenal cortex layers
GFR- salt, sugar, sex
glomerulosa- aldosterone
fasciculata- glucocorticoids
reticularis- androgens
179
21 vs 11 hydroxylase deficiency
```
21 is MC
both cause congenital adrenal hyperplasia - virilization
21 is slat wasting --> hypotension
11 is salt saving --> hypertension
both require cortisol for tx
```
180
RAS pathway
renin from JXA of kidneys
angiotensinogen to angiotensin I by renin (in liver)
angiotensin I to II by ACE in lung
angiotensin II causea vasoconstriction and induces aldosterone release from adrenals
181
primary hyperaldosteronism diagnosis
salt load suppression test (urine aldosterone will stay high)
aldosterone:renin >20
CT with thin cuts
if nothing on CT, get adrenal venous sampling
182
primary hyperaldosteronism treatment
adenoma- adrenalectomy
| hyperplasia- medical therapy (spironolactone, CCB, potassium replacement)
183
Cushing syndrome- MC causes
```
MC pituitary adenoma
#2 ectopic ACTH
#3 adrenal adenoma
```
184
cushing syndrome workup
24hr cortisol urine
low dose dexamethasone test- if low ACTH then adrenal source, if ACTH high pituitary vs ectopic source
high dose dexamethasone - low ACTH pituitary source, high ACTH ectopic source
185
MC causes of hypocortisolism
withdrawal from exogenous
| MC primary dz = autoimmune (TB wordwide)
186
acute addisonian crisis dx and tx
```
cosynotropin test (give ACTH and measure urine cortisol which will stay low)
give dex (will not f up your test)
(treat before test confirmation)
```
187
concerning characteristics of incidentaloma
heterogenous
>10 houdsfeld units
<60% washout
188
adrenocortical carcinoma
bimodal distribution age
50% functioning
open adrenalectomy
Mitotane for unresectable dz
189
catecholamine production
tyrosine --> dopa --> dopamine --> norepi --> epi
| epinephrine is only created in adrenal medulla via PMNT (so only adrenal pheo will produce epi)
190
pheo rule of 10s
```
10% malignant
10% bilateral
10% in kiddos
10% familial
10% extraadrenal (will produce norepi, but no epi)
```
191
pheo diagnosis
initial plasma metanephrine screening
then urine test
then CT and MIBG
192
preop for pheo
```
volume replacement
alpha blocker (phenoxybenzamine) then beta blocker
(appropriate dosage = mildly orthostatic or dry nasal mucosa)
```
193
most common extramedullary pheo?
organ of zuckerkandle (near aortic bifurcation)
194
thyroid vasculature
superior thyroid a - external carotid
inferior thyroid a- thyrocervical trunk
superior/middle thyroid v - IJ
inferior thyroid- innominate v
195
thyroid storm tx
beta blockers
| wolf chaikoff effect- high dose iodine, inhibits TSH induced release of T3 T4
196
workup of asymptomatic thyroid nodule
FNA
if indeterminate- get radionuclide scan
if hot nodule- PTU/iodine
if cold nodule- lobectomy
197
lingual thyroid vs thyroglossal cyst
lingual- in foramen cecum, dysphagia/dyspnea/dysphonia, tx with iodine, resect if this doesnt shrink thyroid
thyroglossal- moves with swallowing, resect
198
side effects PTU and MMA
PTU ok for pregnancy
| both cause aplastic anemia and agranulocytosis
199
hashimotos vs bacterial thyroiditism, de quervains, reidels
hashimotos- autoimmune, lymphocytic infitrate, thyroxine
bacterial- usua after bacterial URI, abx
De quervains- hyperthyroid then hypo, after viral URI, high ESR, steroids
Reidels- woody fibrous, associated with PSC, steroids
200
criminal nerve of grassi
off right vagus (which comes of celiac branch)
201
acid secretion from stomach
```
parietal cells
Vagus --> ach
G cells --> gastrin
histamine
Ach/gastrin --> PKC
Histamine --> cAMP --> PKA
```
202
Secretin
inhibits gastrin reelease
(from duodenum)
increases panc relase of bicarb
203
somato statin
```
aka octreotide
from antrum
hard stop
decreases gastrin
decreases insulin , glucagon
decreases secretin
```
204
MMC phases
```
90min
Phase I- rest
Phase II- GB contraction
Phase III- peristalsis
Phase IV- decel
```
205
Medial v lateral pec n
medial both pec major and minor
| lateral- pec minor only
206
Stewart treves
lymphangiosarcoma 2/2 chronic lymphadenima
| will present as purple nodules 5-10yrs after ax dissection
207
Thoracic duct anatomy
right
crosses to left at T4
enters IJ/subclav
208
rectal vascular anatomy
superior rectal artery (from IMA)
middle rectal a (internal iliac)
inferior rectal a (internal pudendal)
209
rectal v colon cancer management
REctal: preop chemo/xrt if stage II/III
Colon: III, IV postop chemo
210
colorectal cancer staging
T1 submucosa
T2 to muscularis propria
T3 to serosa
STage I- T1/T2
STage II- T3/T4
Stage III- N+
211
Gardners vs turcot vs peutz jeghers
Gardners- colon + desmoid
Turcot- colon + brain
Peutz Jeghers- polyps + mucocutaneous lesions
212
Bowens dz=
SCCA in situ
Imiquimod (topical)
WLE if you have to
213
Heydes syndrome
angiodysplasia of colon
| association with AS`
214
Zenkers where and management
```
Killians triangle (cricopharyngeus and pharyngeal constrictors)
Myotomy
```
215
normal LES location and pressure
40cm from incisors
| 15-25 mmg/hg
216
DES management
CCB
217
blood supply s/p esophagectomy
right gastroepiploic
218
esophageal leiomyoma management
excision (do not bx first)
| if >5cm or symptomatic
219
MC salivary gland tumors (malignant and benign)
1 mucoepidermoid ca
2 adenoid cystic ca
1 pelomorphic adenoma
2 warthins tumor
220
radical neck dissection involves
CN XII, SCM, IJ, submandibular gland
221
freys syndrome
auriculotemporal nerve injury
| causes gustatory sweating
222
MC hepatic artery variants
R hepatic - SMA (20%)
| Left- left gastric
223
Kupffer cells
liver macrophages
224
hemobilia
GIB + jaundice + RUQ pain
| areriogram and embo
225
hepatic adenoma v hemangioma v FNH on imaging
adenoma- cold on liver scan (no kupffer cells)
FNH- central scar, hot on scan
hemangioma- peripheral to central enhancement
HCC- early arterial enhancement, early washout
226
Cushings triad
increased ICP
HTN
bradycardia
Kussmausl respirs
227
ulnar, median, radial n
ulnar- intrinsic hand, wrist flexion, sensation to back of hand and digits 4/5
median- thumb, sensation palm, palmar 1/2
radial n- wrist finger extension, sensation to dorsum 1/2
228
volkmans contracture
supraconydlar humerus fracture
damage anterio interosseous artery
compartment syndrome
pain with forearm extension in flexor sheat (median nerve affected)
229
ewings sarcoma path
onion layering and pseudorossettes
230
MC panc tumors
insulinoma MC overall
| gastrinoma in MEN1
231
gastrinoma triangle
CBD/cystic a junction
neck of panc
third duodenum
232
glucagonoma med tx
octreotide
233
pulmonary sequestration- extra and intralobar
extralobar- systemic a and v
| intralobar- pulmonary v, systemic a
234
TEF classification
```
A- blind pouch x2
B- proximal fistula
C- distal fistula (most common)
D- fistula x2
E- fistula without esophageal pouch
```
235
VATER
vertebral
anorectal
TEF
radial/renal
236
Cantells pentology
omphalocele, cardiac, pericardium, sternum, diaphragm
237
PNMT
adrenal medulla
| norepi --> epi
238
Pheo 10% rule
```
bilateral
pediatriac
malignant
MEN
extraadrenal
```
239
Nelsons syndrome
post adrenelectomy
| increased acth and msh
240
stsg phasese
imbibiation
insoculation
neovascularization
241
melanoma types
superficial spreading (MC)
nodular (aggressive)
lentigo maligna
acral lentigimous
242
gastric ulcer types
```
I- lesser curve
II- lesser curve and duodenum
III- prepyloric
IV_ less curve near cardia
V- NSAID
```
243
chemo for carcinoid
streptozocin
doxorubicin
5fu
244
PTU vs MMA
PTU- cretinism and anaplastic anemia
| MMA- agranulocytossis, avoid in first trimester
245
papillary vs follicular v medullary cancer
papillary- MC, lymphatic spread, psammoma bodies
follicular- hematogenous spread
medullary- lymphatic spread, amyloid on path, parafollicular c cells, gastrin secretion test
246
laryngeal muscle inn
superior laryngeal- cricothyroid
| recurrent laryngeal
247
osteitis fibros cystica
hyperPTH
248
positive DPL
```
>10cc blood
food
bile
bacteria
>100,00rbc
>500 WBC
```
249
silvadene- sulfamylon, silver nitrate adverse effects
SSD- neutropenia
sulfamylon- acidosis
silver nitrate- hyponatremia hypochloremia
250
seminoma vs nonseminoma
seminoma MC, XRT! (chemo if node +)
| nonseminoma- express afp and bhcg
251
#1 nerve injury CEA
vagus
252
atherosclerosis phases
```
foam cells (fat filled MAC)
fibrointimal lesion (smooth m proliferation)
intimal disurpion and thrombus formation
```
253
meigs syndrome
pelvic tumor __> ascites
254
howship romberg
obturator hernia
| innerthigh pain with internal rotation
255
petits and grynfelts hernia
```
petits inferior (iliac crest eternal oblique)
grynfelts superior (12 rib, internal oblique)
```
256
coag lab for liver failure?
PT (VII is shortlest half life)
257
cryo used for
vwd
hemophilia A
DIC
258
vwd types
I- MC, quantitative, AD, ddavp
II- qualitative, AD, cryo
III- quantitative, AR, cryo
259
heparin antidote
protamine
260
aminocaproic acid
procoagulant
| for DIC and thrombolytic OD
261
digoxin dont use with
avoid in hypokalemia (inhibits K/Na pump) will worsen hypokealmiea
262
metyrapone and aminoglutethimide-
inhibit cortisol synth (for adrenal hyperplasia tx)
263
respiratory quotient
0.7fat
0.8 protein
1.0 carb
<0.7 = ketosis and fat oxidation
264
copper deficiency
pancytopenia
265
woundhealing course
inflammation- 1-10d (PMN 1-2d, MAC 3-4d)
proliferation 5d-3wks (fibroblasts) (neovasculrariation) granulation, @3wks collagen II--> I
Remodeling (>3wks)- stable collagen amount
