COACH PRACTICE TEST Flashcards
1
Q
Esophogeal muscle by location
A
upper one third are striated,
lower two thirds are smooth muscle.
2
Q
Barrett esophagus refers to the pathologic change from
A
squamous to columnar epithelium
3
Q
key elements for the manometric diagnosis of achalasia are
A
aperistalsis of the esophagus
and failure of relaxation of the lower esophageal sphincter - regardless of overall pressure
4
Q
relative contraindications for studies of Zenker diverticulum
A
endoscopy
Manometry nonhelpful preoperatively
5
Q
Predictors of a successful outcome in patients with achalasia treated by myotomy and fundoplication include :
A
A. Age >40 years
B. Female sex
C. Presence of esophageal dilation
D. Lower esophageal sphincter pressure >35 mm Hg
6
Q
Predictors of a poor outcome in patients with achalasia treated by myotomy and fundoplication i including operative complications
A
younger age,
male sex,
LACK of esophageal dilation,
<35 mm HG lower esophageal sphincter pressure.
Predictors of increased operative complications include prior pneumatic dilations and botulinum A (Botox®) injections
7
Q
risk for adenocarcinoma of the esophagus
A
obesity - reflux and estrogen up
tobacco for both adenocarcinoma and squamous cell
8
Q
risk for squamous cell carcinoma of the esophagus
A
Cuastic direct tissue injuries:
A. Prior head and neck cancer
B. Caustic injury
C. Alcohol abuse
D. Achalasia
9
Q
T stage for an esophageal cancer that extends into, but not through, the muscularis propria?
A
T2
stage like colorectal
10
Q
adjuvant chemoradiation esophageal carcinoma
A
only stage III and above
stage I AND stage II treated with surgery alone
careful, stage II has nodes but they are along the esophagus
11
Q
The preferred treatment for an instrumental perforation of the esophagus above a long stricture is
A
esophagectomy and immediate reconstruction if caught early
Drain the chest
12
Q
characteristic pain pattern in patients with uncomplicated gastric ulcers is
A
believed to be caused by acid secretion. About one third of patients also report nocturnal pain, again related to acid secretion
13
Q
characteristic pain pattern in patients with uncomplicated Duodenal ulcers is
A
relieved by eating
Stimulate release of bile and bicarbonate to neutralize acid
14
Q
most common gastric ulcer type
A
I
Type I 60%, Type II 15%, Type III 20%, Type IV <10%
15
Q
gastric ulcer type locations
A
Type I
ulcers are located on the lesser curvature to incisura;
Type II
in the body of the stomach,
typically around the incisura,
associated with a duodenal ulcer
Type III
in the prepyloric region;
IV gastric ulcers are juxtoesophageal. Type V ulcers may be located anywhere in the stomach
16
Q
intractable duodenal ulcer should be treated with
A
an acid-reducing operation. This can be a truncal or highly selective vagotomy, with or without an antrectomy.
17
Q
was common cause of death from gastric ulcer
A
perforation
18
Q
was common complication of gastric ulcer
A
hemorrhage
19
Q
operation for obstructing duodenal ulcer
A
Billroth II Vagotomy Antrectomy draining gastrostomy Feeding J.
20
Q
most common cause of marginal ulceration is in patients with
A
Roux-en-Y gastric bypass
Bilroth II operations. Marginal ulcerations do not occur unless the jejunum is anastomosed to the stomach
21
Q
medication to inhibits gastrin release
A
beta-blockade
counterintuitive-stress adrenaline state increases acid secretion “your going to get an ulcer”
22
Q
stimulation of gastrin
A
A. Digestive proteins B. Calcium C. Achlorhydria D. epinephrine E. Gastric distention
23
Q
the initial biochemical cure rate of sporadic ZES cases?
A
only 50%!
24
Q
The tear of the mucosa in cases of the Mallory-Weiss syndrome is usually located
A
Just below the gastroesophageal junction, lesser curvature OF THE STOMACH!!
Although commonly referred to as tears of the mucosa of the distal esophagus, the most common site is just below the gastroesophageal junction, namely the cardia of the stomach, along the lesser curvature of the stomach. Cameron p 78
25
Mallory-Weiss management of bleeding
endoscopic treatment such as clip application, epinephrine injection, or endoscopic banding.
Surgery is rarely required,
done via a proximal anterior gastrotomy with suturing of the tear.
26
most accurate in detecting the depth of invasion of gastric cancer.
EUS
CT is used to check for distant metastases, and peritoneal washings when positive predict a short mean survival time
27
D2 dissection refers to removal of the lymph nodes along the main trunks of the
celiac artery
28
indications for D2
live in Japan
29
D1 lymphadenectomy
periGastric nodes
30
Neoadjuvant therapy used for what kind of gastric cancer findings
T2 or higher tumors (those invading the lamina propria or submucosa). Cameron pp 82-33
31
Adjuvant imatinib as recommended for what gastrointestinal stromal tumors
3 or greater centimeters
Continued but diminished benefit at 3 years
32
Anastomotic obstructions after Roux-en-y gastric bypass can usually be managed by:
endoscopic balloon dilatation!
Strictures can occur in the first few months of the surgery and do usually respond to dilation
33
what percentage of small bowel obstructions resolve spontaneously
75% all comers
careful, high-grade obstructions will require operation 80% of the time and should receive it within 24 hours of not improving
34
how long to use it on a high-grade partial small bowel obstruction
24 hours!
35
CT protocol ordered for small bowel obstruction
IV contrast only
36
incidence of cancer causing intussusception an adult
50%
95% of time it is some kind of mass at only 50% of those will be a cancer
37
Crohn disease has 3 major phenotypes. These are:
inflammatory, stricture, fistula
38
Which of the following treatments for Crohn disease is associated with an increased risk of infection
Infliximab
The anti-TNF alpha class of drugs is associated with an increase in infection and reactivation of latent infection
39
early postoperative medical therapies to suppress recurrence of Crohn disease after surgical treatment
A. Mesalamine, sulfasalazine
B. Azothioprine, 6-mercaptopurine
C. Infliximab
metronidazole for 3 months postoperatively has been shown to reduce endoscopic recurrences, and long- term smoking cessation
reduces recurrences by about 50%.
40
Why aren't stricture plasties performed:
Risk of cancer
41
best test for carcinoid tumors
chromogranin A
now the preferred test
also useful in postoperative surveillance
highly sensitive, it is not very specific for carcinoid tumors.
42
Extensive fibrosis is characteristic of which of the following small bowel tumors
carcinoids
neuroendocrine secretion
The fibrosis may cause mesenteric shortening, vascular obstructions, and bowel obstructions.
43
utility of imatinib in GIST of small bowel
yes indeterminate and higher risk
44
In younger patients, adenocarcinoma of the small bowel most commonly is found in
the jejunum
45
Adenocarcinoma of the small bowel in patients over 50 years of age is found most frequently in the:
duodenum
46
Lymphomas of the small intestine appear most frequently in the:
Most small bowel lymphomas are diffuse, large B-cell lymphomas. Patients with HIV and low CD4 counts also develop B-cell lymphomas of the small intestine. Additionally, patients with celiac disease are at very high risk for the development of small bowel lymphoma, typically non-Hodgkin T-cell lymphoma
47
length of bowel surface increased with STEP and percent weaned from TPN
50%
| 50% - this is improved for subsequent STEPs
48
Bianchi procedure percent weaned from TPN
80%
49
treatment of Hinchy III and IV
Hartmann procedure or a diversion
with coverage with an omental patch and drainage is appropriate.
NOT with primary resection and anastomosis, even with proximal fecal diversion unless contamination was limited, which generally is not true with Hinchey III and IV cases. Cameron
50
procedures is appropriate for a patient undergoing emergent surgical treatment of ulcerative colitis
Subtotal colectomy and ileostom
Don't take the rectum increase operative time
51
lab marker finding with ulcerative colitis
p-ANCA
Anchor at the bottom UC is rectal
52
most likely region to perforated colon with toxic megacolon
splenic flexure is a “watershed” region, and this may account for the perforations at this site of ischemia
not the cecum with as an endoscopy
53
Which region of the colon is least likely to develop ischemic colitis?
rectum
54
The gold standard confirmatory study in cases of suspected ischemic colitis
colonoscopy
55
The most sensitive test for detecting C. difficile
```
Toxin B-detecting tissue culture method
CULTURE
BUT...
the tissue culture method requires 24-48 hours whereas the immunoassays require only a few hours:
Rapid enzyme immunoassay
```
56
he most common cause of large bowel obstruction in the United States is:
90% of colon obstructions are the result of cancer. Adhesions from prior surgery almost never cause colonic obstructions.
incarcerated inguinal hernias relatively rare
57
The most common complication of colonic stenting is
Stent migration occurs in 12%-15%, reobstruction in 4%-6%, and perforation in 2%-4%.
58
contraindications of using neostigmine
pregnancy,
hypotensive patients,
bronchospasm.
59
The underlying problem in patients with the solitary rectal ulcer syndrome - and what is treatment
absence of the normal mesorectal fixation in these patients.
tx:
ranges from
rectopexy with sigmoid resection to
stapled transanal rectal resection.
60
Which of the following is/are useful for the treatment of radiation-induced proctitis
A. Nd:YAG laser
B. Argon beam coagulation
C. Topical formalin
These are not as effective:
sucralfate, steroids, and short chain fatty acids.
61
The preferred treatment for radiation enteritis complicated by obstruction is:
resection of the involved bowel WITH ANASTOMOSIS
morbidity is about the same for bypass and resection, the long-term results are better in patients who undergo resection.
62
APC gene is what type,
tumor suppressor gene
63
Familial adenomatous polyposis In addition to the near certain development of colon cancer, affected patients may develop
```
desmoid tumors,
hypertrophy of retinal pigment,
osteomas,
fibromas,
epidermoid cysts.
```
64
in FAP benefit of an ileal-anal pouch anastomosis (IPAA) over performing an ileorectostomy (IRA)
decrease in duodenal adenoma formation after ileal-anal pouch anastomosis
thought to be due to decreased secondary bile production and reduced exposure of the duodenum to potential carcinogens as a result
65
Dreyfus model of performance first begin to demonstrate ability to apply knowledge of the known to new or unknown situations and is the surgeon able to successfully have experience supplant rules?
The novice and the advanced beginner basically function by following rules. Once the learner is competent, he begins to have experience supplant rules.
66
What hormone stimulates glycogenesis and glycolysis?
Insulin stimulates glycogenesis, the formation of glycogen from glucose
conversion of glucose to pyruvate or lactate.
67
Glucagon stimulates
glycogenolysis converting glycogen into glucose,
and
gluconeogenesis from amino acids, glycerol, or lactate.
Thus, glucagon raises blood suga
68
bile acid excreted in the feces with small amount is reabsorbed
Lithocholic acid via sulfiation
69
Secondary bile acids,
```
deoxycholic acid
lithocholic acid ( excreted and feces)
```
are formed in the colon by bacteria degrading the primary bile acids.
70
primary bile acids
cholic acid
chenodeoxycholic acid.
They are formed from cholesterol in the liver
passively reabsorbed in:
the small intestine and liver,
actively absorbed in the ileum.
71
lean body mass and changes of cellular make up in elderly
net decrease of lean body mass.
extracellular mass stays about the same,
body cell mass decreases,
fat mass increases
72
In surgical patients with inflammatory states, white is seen regarding glucose used to amino acids, ketone production, responsiveness and dextrose
production of glucose from amino acids is increased
production of ketones is less robust
less response to dextrose infusion than in simple starvation
73
convert nitrogen to protein
protein divided by 6.25
74
The earliest IL response is
IL-1.
Another early response is TNF.
TNF and IL-1 peak early and they both stimulate the release of IL-6.
75
In severe injury, which of the following factors is/are increased greatly compared to those responses in simple starvation?
A. Hepatic ureagenesis
B. Nitrogen loss
C. Gluconeogenesis
D. Muscle proteolysis and hepatic protein synthesis
There is utilization of fat in simple starvation, but not so in patients with severe injury in which there is protein breakdown and decreased ketogenesis from fat.
76
counter-regulatory hormones in response to injury/trauma?
INCREASE:
```
ACTH
ADH
GH
Glucagon
Catecholamine release,
Cortisol release,
Aldosterone release,
```
mobilization of amino acids from skeletal muscle
77
“regulatory” hormone in response to injury/trauma?
Insulin
78
For patients in hepatic failure with encephalopathy, if total parenteral nutrition is required, it should have what proteins
Contain branched chain amino acids
CONTRAINDICATED:
aromatic amino acids - already have ketone breath and are goofy
79
needle catheter jejunostomy and the Witzel jejunostomy in trauma patients, which has a higher complication rate?
Witzel technique was reported to be 10% vs 2% with the needle catheter technique
80
Glutamine has been demonstrated As added TPN
improve villous atrophy
safe to administer
diminishes complications
shortens length of stay.
However, it is relatively unstable in solution and has a short half-life
81
he energy source for colonocytes
short chain fatty acids are produced in the colon by bacterial fermentation of ingested fiber
82
rate of thrombosis when studied by phlebography with central venous line
30%
3% clinial
83
The intrinsic pathway of activation of clotting is initiated by:
Conversion of XI to XIa
84
If D-dimer is still elevated 30 days after discontinuation of therapy,
then further treatment is indicated as there is an increased risk of DVT recurrence.
85
hypercoagulable states associated with artial thrombus
hyperhomocysteinemia
86
protein C and protein S deficiency onset of sympts
15-30 yrs
homozygous, there is usually fetal death
87
In the evaluation of a patient suspected of having a hypercoagulable state (such as a young patient with an unproved major DVT or arterial thrombosis), which of the following tests is/are appropriate?
A. Protein C
B. Protein S
C. Factor V Leiden
D. Factor VIII, IX, XI
88
The most common inherited bleeding disorder is
vonWillebrand disease
89
Where do B lymphocytes origionate and immature
bone marrow
Lymph nodes
Spleen
Mucosal lymph nodules of the tonsils
Lymph nodules of peyers patches
90
where do T lymphocytes origionate and mature
bone marrow
thymus only
91
acute phase proteins that DECREASE in response to inflammation, trauma of various sorts, hemorrhage, and ischemia
Albumin, prealbumin, transferrin
92
Major factors in reperfusion injury include
complement activation
| Neutrophil recurrent
93
The National Nosocomial Infection Surveillance System (NNIS) expands upon the risk of post-surgical wound infections by including which of the following factors
```
ASA class greater than 2
duration of operation greater than 75th percentile
```
94
organisms cultured from the peritoneal cavity is indicative of secondary rather than tertiary peritonitisA
Escherichia coli
95
Organisms associated with tertiary peritonitis
pseudomonas
Candida
Enterococcus
Coagulase-negative staphylococci
96
Which species of Clostridium is associated with GI malignancies
Clostridium septicum
bovine?
97
Confirmation of central line infection when blood cultures drawn from the central line and from a peripheral site grow the same organism, providing that the central line sample:
Grows ≥5 times the number of organism
Grows organisms ≥2 hours BEFORE than the peripheral sample
98
Post-antibiotic effect” is characteristic of which of the following drugs
aminoglycoside
inhibition of bacterial growth after drug level had fallen below the MIC
aminoglycoside increased Killing bacteria when drug level is increased well beyond MIC
99
major change of class II hemorrhagic shock
narrow pulse pressure
Diastolic INCREASES
100
Pressors metabolized by the liver
The D's
dobutamine
Dopamine
all others are metabolized the kidney
101
physiologic complication of milrinone
hypotension and decrease afterload
102
use of recombinant activated protein C (APC) in the treatment of severe sepsis
That earlier reports have not been substantiated and that APC was not of value in the treatment of severe sepsis
increased risk of serious bleeding
103
About what percent of all hospital costs are related to the expenses of the intensive care units
33%
104
response of hypoxia from pulmonary embolism with increased FiO2
improvement in hypoxia
not true of ARDS
105
Reduction of blood transfusions has been shown to benefit ICU patients. Which of the following has been shown to be neither cost effective nor of appreciable clinical benefit
weekly recombinant human eryththropoietin to boost red cell production
106
Reduction of blood transfusions has been shown to benefit ICU patients. Which of the following has been shown to be cost effective / appreciable clinical benefit
Use of pulse oxymetry rather than blood gas analysis to check oxygen levels
Use of capnography rather than blood gas analysis to check carbon dioxide levels
107
Which of the following physiologic stresses results in the greatest metabolic requirement
```
A. Uncomplicated operation - 1.1
B. Peritonitis - 1.25
C. Long bone fracture - 1.25
D. Multiple organ failure - 1.5
E. 40% BSA burn - 1.75
```
108
Which of the following increase hepatic glucose production
A. Glucagon
B. Norepinephrine
C. Epinephrine
user all counter regulatory hormones but increase blood sugar and
109
major benefit of increased blood glucose control and critically ill
decrease sepsis induced organ failure
110
with prerenal failure what is urine sodium
less than 1% FENa
aldosterone is increased - increased sodium resorbs
111
The plasma osmolality is estimated by doubling the value of the serum sodium and then
Adding glucose/18 + BUN/2.8
112
The mechanism by which ADH changes urine osmolality is by
Urine osmolality is controlled by ADH secretion from the posterior pituitary as well as by regulation of thirst.
ADH Altering the permeability of collecting tubules to water with high levels making the collecting tubules more permeable to water
113
The arterial baroreceptors are located in the
all muscular arteries - effects fluid
Careful, carotid body is a CHEMOreceptor - effects rate
114
Low pressure baroreceptors are located in vessels that are distensible and not affected by sympathetic stimulation. They are located in the:
Intrathoracic vena cava
atrium
measure central venous pressure
115
Increased aldosterone results in
sodium resorption
Potassium excretion
Conn's syndrome - hypertension hypokalemia
116
renin angiotensin access described cleavage and locations
Renin cleaves angiotensin I to angiotensin II -
lungs.
Angiotensin II increases sodium reabsorption from the renal tubules and also stimulates the release of aldosterone from the adrenal cortex (zona glomerulosa).
117
palate is insensible fluid loss related to fluid restriction
not
118
insensible fluid loss effects from ventilatory support
the increased fluid decrease loss with humidified air being given
119
Administration of large volumes of normal saline may result in
hyperchloremic metabolic acidosis
possibly hypernatremia
120
body fluid with the highest concentration of potassium
Saliva-20
Colonic secretions may have as much a 70
121
Colonic electrolyte losses
potassium-60-70
| Significant bicarbonate loss
122
diagnosis with hypernatremia and hypotension
diabetes insipidus the
123
patient the present with hypertension and hypervolemia medical causes
hyperaldosteronism
Hyper cortisol
Order renal failure
124
hypernatremia hypervolemia what is the diagnosis
SIADH
125
SIADH treatment
fluid restriction
Symptomatic:
Hypertonic saline
Did not exceed rate of 0.5 per hour
12 mEq per day
```
Calculate:
the total body water x12 mEq equals the total amount of sodium per day required
70k man = 42 x 12 = 504 meq / day
513 meq = Na in 1L 3%saline
1000 ml /24 = 40 ml / hr a
```
126
quick and dirty water deficit with sodium of 170
water deficit equals sodium excess
170-140 = 30 / 3 = 10
127
official calculation of water deficit and hypernatremia
```
desired change and sodium times x total body water
/divided by/
normal sodium (140)
```
128
For a patient on floor care without ECG monitoring, what is the maximum recommended rate of IV administration of potassium to correct hypokalemia
10 mEq/hr
129
malignancies has been associated with hypercalcemia
squamous cell carcinoma of the lung
130
extrapulmonary symptoms associated with adenocarcinoma of the lung
clubbing
| Gynecomastia
131
extrapulmonary symptoms of small cell carcinoma of the lung
SIADH
132
Which of the following drugs is/are associated with hypomagnesemia?
A. Cyclosporine
B Aminoglycosides
C. Cis-platinum
D. Insulin
133
The body buffering system tries to maintain a pH of 7.4. This is done by keeping the ratio of bicarbonate to carbon dioxide at about
20:1
134
Which of the following types of fistulae is most likely to result in metabolic acidosis
pancreas loss of bicarbonate
Pancreas bicarbonate is 150
gastric bicarbonate 50
ileum and colonic secretions 50
135
vascular effect of metabolic acidosis
arterial DILATION
Cardiac DECREASED contractility
136
The level of carboxyhemoglobin that is associated with the onset of confusion, stupor, and weakness is about:
35%
137
Which topical antimicrobial agents used in the treatment of burns inhibit carbonic anhydrase and affect
Mafenide "ACETATE"
Sulfamylon
metabolic acidosis
138
advantages of burn excision and grafting
A. Shortened hospital stays
B. Lower costs
C. Decreased need for later reconstructive surgical procedures
performed 3-4 days postburn
139
Advantage of debridement down to fascia versus tangential excision
down the fashion is less bleeding
A worse cosmetic result
140
Which of the following protocols will result in the highest number of nontherapeutic open laparotomies for abdominal stab wound
Wound exploration; if no peritoneal penetration, then discharge home. If peritoneal penetration, then open laparotomy
but also results in lowest number of missed perforations the
141
The appropriate scanning technique for visualizing splenic injuries should be timed to show which phase of the circulation?
portal venous phase -
this catches splenic parenchyma and active extravasation that show up as blush
careful, not arterial phase for arterial blush need delay
142
nerve that innervate plantar surface of the foot
tibial nerve
Part of the reason cannot salvage if tibial nerve was injured - no foot sensation plantar surface
143
type of snake in the United States that is most dangerous-what his treatment, with his major toxicity
Crofab antivenin is highly effective for pit viper bites.
144
coral snake symptoms
coral snake-
neurotoxicity with respiratory failure - may take 24 hours to manifest
little local tissue injury
145
treatment of brown recluse spider bite and mechanism
dapsone, 100 mg/day
reduce local inflammation by inhibiting white cell function.
146
presentation a brown recluse spider bite
tissue ischemia and then ulceration as a result of microthromboses.
Early debridement is contraindicated.
147
complication of treatment of brown recluse spider bite
In patients with glucose-6-phosphatase dehydrogenase deficiency, it may result in:
methemoglobinemia
measure this enzyme if give Dapsone
148
when his of bowel injury most commonly seen in black injury victims
underwater
149
first second and third most common cancer deaths and
Lung and leeding causing than and women
colon
Prostate
150
first second third most common cancer deaths in females
Lung and leeding causing than and women
Breast
colon
151
Which of the listed monoclonal antibodies targets HER2/neu
Traztuzumab
| Herceptin
152
Abciximab mechanism
GPIIb/IIIa inactivates platelets
153
Bevacizumab mechanism
Avastin
targets VEGF decrease angiogenesis
154
infliximab mechanism
Remicade
tumor necrosis factor alpha
155
associated cancer with perineal Paget's disease
gastrointestinal
AND
Genitourinary
156
neoadjuvant and adjuvant radiation and chemotherapy for sarcoma indications
adjuvant radiation:
(>5 cm) high Grade or low grade ( not confined to subcutaneous or intramuscular)
Surgery alone:
subcutaneous or intramuscular high-grade sarcomas smaller than 5 cm,
or
any size low-grade sarcoma, surgery alone should be considered if adequate wide excision with a good 1- cm cuff of surrounding fat and muscle can be achieved.
chemotherapy depends on the histologic type of sarcoma.
Neoadjuvant chemotherapy is almost always indicated for:
Ewing's sarcoma–PNET
rhabdomyosarcoma
extremity sarcomas larger than 10 cm
For patients with other histologic types of high-grade sarcoma, the role of chemotherapy remains controversial.
neoadjuvant combination chemotherapy adult soft tissue sarcoma has several potential advantages, particularly for the treatment of locally advanced tumors:
1 It can make subsequent surgery easier.
2 It may treat micrometastatic disease early before the acquisition of resistance.
3 It leaves the vasculature intact for improved drug delivery.
4 It enables assessment of therapeutic response or resistance to therapy.
157
when he is more aggressive approach for treatment of lip cancer needed
tumor depth greater than 4 mm-increase node positivity
Tumor greater than 3 cm
clinically positive nodes
supraomohyoid neck dissection
Adjuvant radiation
158
indications for adjuvant radiation for lip cancer
```
tumor depth greater than 4 mm
Tumor size greater than 3 cm
Clinically positive neck
Perineural involvement
Close tumor margins
```
159
BI-RAD
1
160
which hormone therapy medication should be used for postmenopausal women for breast cancer
Raloxifene
A. Reduction in the number of uterine cancers
B. Fewer episodes of venous thrombosis
C. Reduced incidence of pulmonary embolism
the
161
Which type of breast cancer rarely is found in men
lobular carcinoma
Men do not have lobules
162
utility of thyroglobulin preoperative level and thyroid cancer
none
163
sonographic findings in thyroid masses is/are considered suspicious for malignancy
A. Microcalcifications
B. Hypoechoic compared to the surrounding tissue
C. Taller than width on the transverse view
ultrasound findings were thyroid or same breast
164
treatment of neck related migratory erythematous dermatitis with gastrinoma and
amino acids
165
sonographic findings in thyroid masses is/are considered suspicious for malignancy
transhepatic
though, splenic route as possible
166
In patients with Cushing syndrome, as opposed to Cushing disease, the ACTH level should be
cushing SYNDROME
adrenal source
Negative fee back to ACTH
167
most common organisms and antibiotic of choice for cirrhotic patient with concern for infected peritoneal fluid
Escherichia coli
Klebsiella pneumoniae
third-generation cephalosporin
168
organisms associated with nephrotic syndrome
gram-positive
Streptococcus
Staph aureus
Strep pneumoniae
169
volvulus and pregnancy
25% of obstructions
Second and third trimesters
170
brisk gastric bleeding, Dieulafoy lesions most common anatomic site
lesser curve of the stomach
| near gastroesophageal junction
171
Dieulafoy treatment
endoscopic therapy or embolization
172
most common site of aortoenteric fistula after AAA - what is initial workup
Third and fourth portion of duodenum
endoscopy Initial
CTA not recommended initially
173
why are bleeding scans notoriously inaccurate for location of bleeding in the colon
to and fro motion of the colon
174
eradication of H. pylori, the preferred test is:
The urease breath test at 4 weeks post-treatment
175
treatment of blind loop syndrome after Billroth II for duodenal ulcer
revision to Billroth I
anastomosis between a affarent and efferent loops
conversion to Roux-en-Y
176
Malignant neoplasms of the small intestine may cause some pain and more commonly produce what symptoms
initial weight loss
May cause pain
Obstruction
Malignancy of the small bowel is more associated with obstruction than intussusception
177
The appropriate management for a patient with an asymptomatic duodenal diverticulum is
observed
less than 1% become symptomatic
surgical intervention carries significant morbidity and mortality.
178
possible complications seen with duodenal diverticula
```
perforate
stasis with resultant bacterial overgrowth,
malabsorption,
steatorrhea,
meagaloblastic anemia
```
179
enteroclysis
fluoroscopic X-ray of the small intestine.
Radiocontrast is infused through NG into duodenum,
real time as the contrast moves through aided by administration of methyl cellulose
180
small bowel follow-through
also called small-bowel series
Person DRINKS radio-opaque contrast.
X-ray images of abdomen are made at timed intervals.
181
upper GI series
also called a barium swallow
Person DRINKS radio-opaque contrast barium.
small bowel follow-through that INCLUDES:
```
esophagus
AND
stomach
AND
duodenum
```
182
meandering mesenteric artery (arc of Riolan)
The superior mesenteric and inferior mesenteric arteries
183
Hartmann procedure
surgical resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy.
184
The lifetime colorectal cancer risk in patients with familial adenomatous polyposis (FAP) is
100%,
185
lifetime colorectal cancer risk for patients with the hereditary nonpolyposis (HNPCC) cancer is .
80%
186
What is the most commonly associated cancer in patients with FAP
duodenal and periampullary adenocarcinoma
187
What is the most commonly associated cancer in patients with HNPCC
endometrial cancer 50%
188
Stage for stage, the prognosis of patients with HNPCC vs non-HNPCC is:
better!
Like MEN medullary thyroid cancer
189
N stage colorectal cancer
NI 1-3
| N2 4 or greater
190
Which germline gene mutation is associated with the hereditary nonpolyposis colorectal cancer syndrome
mismatch repair gene
191
other colorectal cancer gene mutations onco gene versus tumor suppressor
oncogene:
myc
ras
Tumor suppressor:
DCC
P. 53
192
Which of the following is the most common type of anal fistula
intersphincteric
others in order:
Transsphincteric
Super sphincteric
Extra sphincteric
193
Goodsall rule predicts that a fistula presenting posterior (dorsal) to the 9-o’clock to 3-o’clock axis will have its internal opening:
In the midline posteriorly
back door is curvy
anterior to radial
194
That vein returns oxygenated blood from the placenta to the fetus via its connection to the:
LEFT portal vein, then the ductus venosus, the inferior vena cava to the right atrium
195
with the umbilical vein called after it closes
ligamentum teres
also called round ligament
this recannulize is portal hypertension
196
The falciform ligament separates liver segments
II and III from segment IV of the functional left lobe of the liver
197
the left lobe of the liver contained with segments
234
198
lobe was spared and Budd-Chiari syndrome
one-caudate
199
we are to the caudate lobe get portal inflow from and where it is a drain into
both left and right portal veins
| drains directly into IVC
200
When performing a choledocho-duodenostomy, which is the proper description of the directions of the incisions
both longitudinal and to create spatulating
201
Following severe pancreatitis, arterial hemorrhage is most likely from involvement of the
splenic artery
also site of thrombosis - This is most, asymptomatic
202
what stages of pancreatic cancer are node negative
I
| IIA
203
Current NCCN guidelines for the treatment of resectable pancreatic adenocarcinoma recommend What approach with neoadjuvant or adjuvant
Some form of adjuvant therapy ( chomo or chemoRADIATION) is recommended following pancreatic resection
204
The functional residual capacity of the lung is the
expiratory reserve volume and the residual volume
205
Regarding lung cancer, N2 disease is defined as metastasis to mediastinal or subcarinal lymph nodes. Patients with N2 disease are classified as:
Stage III
stage IIIa lung cancer as may be resected that require neoadjuvant or adjuvant
206
Nonseminomatous mediastinal tumors are best treated with:
Chemotherapy
207
The repair of Tetralogy of Fallot in infancy have what complication later in life
pulmonary valve insufficiency
208
coronary artery oxygen extraction percentage
75%
most desaturated blood in the body coronary sinus
209
Coronary vessel disease is related to plaque formation. Which of the following makes a plaque prone to rupture
thin fibrous cap
large eccentric soft lipid course
inflammation within the And adventitia
INCREASED neovascularity
210
Which degree of luminal narrowing is correctly matched with the symptoms
75% stenosis EXERTIONAL angina
90% stenosis angina at rest
211
patency rate of internal thoracic artery versus saphenous
Internal thoracic artery:
95% at 10 years
90% at 20 years
Saphenous:
60-70% at 10 years
(90% at 1 year)
212
ruptured abdominal aortic aneurysms, which of the following steps
A. Supraceliac control of the aorta
B. Division of the triangular ligament of the left lobe of the liver
C. Use of a nasogastric tube to facilitate identification of the esophagus
213
which type of endoleak should be addressed at once
type I-failure to seal the aneurysm
214
Endoleaks
I Inadequate seal at the proximal (Ia) or distal (Ib) attachment site
Type I endoleaks are repaired as soon as they are discovered. These leaks rarely if ever close spontaneously.
II Flow into the aneurysm sac from an aortic branch vessel (e.g., inferior mesenteric artery or lumbar artery)
close observation with short interval serial imaging may be appropriate.
III Endograft fabric tear or failure of seal between graft components
Treatment with additional stents to cover the leak is indicated as soon as they are discovered to exclude the sac from systemic pressure.
IV Endograft fabric porosity
generally resolve spontaneously with reversal of anticoagulation.
type V endoleak, endotension is the term for elevated aneurysm sac pressure leading to sac expansion in the absence of a radiographically documented endoleak.
215
You suspect the popliteal artery entrapment syndrome in a young athletic college student. The diagnostic procedure of choice is:
MRI
216
4 risk factors for blunt carotid artery injury (dissection)
A. Near-hanging with anoxia
B. Closed head injury with diffuse axonal injury and GCS <6
C. Seat belt neck abrasion with significant swelling
D. Fractures at C1-C3
217
treatment of traumatic blunt carotid artery injury (dissection)
anticoagulation
218
List hypercoagulable states (8)
```
Factor V Leiden mutation
Protein C deficiency
Protein S deficiency
Homocysteinemia
Antithrombin 3 deficiency
Antiphospholipid syndrome
Lupus antibody
Anticardiolipin antibody
```
219
Neuroblastoma most commonly presents where
adrenal gland
Can arise anywhere there are sympathetic ganglia
220
management of ventriculoperitoneal shunt for hydrocephalus inpatient with appendicitis
and the absence of perforation, do not need to externalize shunt
Shunt tubing in seen during procedure-place away from operative site
