DECJ Flashcards
(457 cards)
1
Q
Tx of SIADH
A
fluid restrictiondemeclocycline or vaptans (adh inhibitor)
2
Q
Portal vein thrombosis tx
A
Control HMHG with variceal ligationAnticoagulate once bleeding controlledConsider distal spleno-renal shunt
3
Q
MRSA tx
A
vancomycinif vanc resistant then linezolid
4
Q
VWF
A
binds GP1b on PLTs and attaches them to endothelium
5
Q
Margin for invasives cancer vs. dcis
A
invasive cancer- gross negativedcis- 1 to 2 mm
6
Q
Interleukins 1, 2, 4
A
IL1: feverIL2: T cell prolif and Ig productionIL4: T/B cell maturation
7
Q
Ovarian tumor markers:AFPCEAHCGLDHCa 125Inhibin
A
AFP: yolk sac tumor, endodermal sinusCEA: mucinous ovarian tumorHCG: ovarian choriocarcinoma, embryonal carcinomaLDH: dysgerminomaCa 125: epithelial ovarian tumorsInhibin: granulosa cell tumor
8
Q
Hormones that increase LES pressure
A
GastrinMotilin
9
Q
Origin of med thyroid cancer
A
4th pharyngeal arch NCC –> parafollicular C cells
10
Q
Gardner syndrome
A
epidermal cysts, GI polyposis, osteomas
11
Q
Indidcations for operative treatment of eso perf
A
early postemetic perforation hemodynamic instability intra-abdominal perforation extravasations of contrast into adjacent body cavities presence of underlying malignancy, obstruction or strictureplace jejunostomy tube for feeding after. don’t place gastric tube (conduit)
12
Q
Uremic PLT dysfunction
A
2/2 renal diseasereversible dysfunctiontx- ddavp
13
Q
B12 def
A
megalo anemia, neuropathy
14
Q
Traction vs. Pulsion Diverticulum
A
traction- inflammation; all 3 layers; mid esopulsion- pressure; 2 layers; above circoph.
15
Q
Positioning for indirect laryngoscopy
A
sitting upright with a straight back, leaning slightly toward you with chin pointing upward (“sniffing position”)
16
Q
Kcal per macronutrient
A
protein = 4 kcal/gdextrose = 3 kcal/glipid = 9kcal/gcarb = 4 kcal/g
17
Q
p53
A
TSG on Ch17cell cycle regulation and apoptosis
18
Q
Rule of 9s
A
Each arm 9Each leg 18Ant belly 18, Post belly 18Each hand 1Ant face 4.5, Post face 4.5Genitals 1
19
Q
EBV associated with
A
B cell lymphome (Burkitt)n/ph cancer
20
Q
FRC
A
Volume of the lung after normal tidal expiration
21
Q
Cisatracurium
A
non-depolarizingcleared by Hoffman degradationuse in pts w/ renal and hepatic disease
22
Q
tacro
A
MOA: calcineurin inhibitor (binds fK)s/e- nephrotoxic, p. neuropathy, allopecia
23
Q
SD
A
1, 2, and 3 SD = 67%, 95%, and 99.7% of the data
24
Q
Intraductal papilloma
A
MCCO bloody nipple d/ctx w/ duct excisionno increased r/o ca
25
Blood supply to esophagus
Upper 3rd- inferior thryoid arteryMiddle 3rd- thoracic aortaLower 3rd- left gastric
26
Pleomorphic adenoma
MC benign H/N tumormiddle aged womanslow growing; t2 brightTx: superficial parotidectomy even if asx
27
Rule of 6s
flow > 600/mindiameter > 6mm (after placement)depth of 6mm
28
Comparing pressors
Norepi: alpha1 > alpha2, beta1Epi: beta1, alpha1 > beta2, alpha2Phenylephrine: alpha1 > alpha2 (no beta)
29
MCCO of spontaneous bacterial peritonitis
E. Coli
30
Max dose of lido and bupiv
lido = 5mg/kg (7 w/ epi)bupiv = 2.5 mg/kgtx- lipid emulsion
31
Lamivudine
rTranscriptase inhibitorTx for hep B at low doses; HIV at high doses
32
Wound healing order of entry
plts → PMNs → macrophages → fibroblast → keratinocytes
33
5Ts of cyanosis
TOF Transposition of GVs Truncus art Tricuspid atresia TAPVC
34
Pain after inguinal hernia repair
Ilioinguinal nerveInjured at external ring. Lies anterior to cordtx- local injection
35
Staging adrenal cancer
s1- <5cms2- >5cms3- n1 or t3s4- mets
36
location of vagus nerve
LARPleft anterior, right posterior to esophagus
37
Dopamine dosing
low- d1/2 ago (renal dose)medium- B agohigh- A ago
38
LIPID A
Gram negative bacteria (Klebsiella)lipopolysaccharide layer endotoxin → septic shock
39
Beta lactamase inhibitors
Sulbactam/TazobactamClavulanic acid
40
Contents of ant triangle
Carotid sheath, anca cervicalis, CN 12 (hypoglossal)Contents of carotid sheath: CN10 (vagus), CCA, ICA, internal jugular facial vein is the gateway
41
BRCA risks
female breast, ovarian, male breastI- 60, 40, 1II- 60, 10, 10Women with BRCA breast CA have the same prognosis stage for stage as non-BRCA breast CA
42
Kasabach-Merritt Syndrome:
hemangioma + thrombocytopeniausually infantsresect!
43
Traumatic renal artery thrombosis
Unilateral- anticoagulationBilateral- OR or IR stent
44
Adenoid cystic carcinoma
MC minor salivary gland tumor (SM gland)propensity for perineural invasionRemains quiescent for years then metastasizes aggressively
45
SLNBx for melanoma
< .75 mm none> .75 to 1 mm w/ ulceration, mitosis, invasion
46
Hernia repairs:BassiniMcVayLichtenstein
Bassini: CT to ILMcVay: CT to cooper'sLichtenstein: mesh
47
Casues of increased ETCO2
Increased muscle activity (shivering)Increased metabolism (sepsis, fever, malignany hyperT)Increased CODecreased minute ventilation
48
Acute cellular rejection
T cell mediatedpath: portal cellular infiltrate + endotheliitistx: pulse steroids → consider thymo
49
Phyllodes tumor
“sarcoma of the breast”tx- en bloc resectionhematog spread- chemo/LN dissection unnneccesary
50
Birads 0
More imaging: mammogram or targeted US
51
Mediastinal tumors
Anterior: lymphoma MC in children, thymoma MC in adultsMiddle: lymphoma MCPosterior: neurologic MC
52
Vitamin C
hydroxylation of lysine and prolinetype 3 collagen cross-linking
53
Staph virulence factors
protein A: binds Fc component of IgG, forcing variable region to face away from bacterium Enterotoxins: intestines Toxic shock syndrome toxin-1 (TSST-1): superantigen. binds MHC II and T-cell receptor Coagulase: converts fibrinogen to fibrin clot Exfolatins: skin-exfoliating toxins
54
CN11
spinal accessory nerveexit jugulars forameninnervates SCM and trapezius goes along post triangle
55
Tx of SVC syndrome
Angio stenting and steroids for sxatic reliefUrgent chemo/rads therapy
56
Silvadene, mafenide, silver nitrate s/e
Silvadene: s/e- neutropenia, hypersensitivity, kernicterus (avoid in preg)Mafenide: psuedomonas coverage s/e- met acidosisSilver Nitrate: s/e- hypoNatremia
57
Indications for radioiodine thereapy
2-4 cm massvascular invasionanti-Tg AbTG < 5
58
Hemophilia A
f8 DEFICIENCY SLRMC inherited disordertx- DESMOPRESSIN (mild), f8 concentrate (severe)
59
Strongest layer of bowel
SM
60
Contents of post triangle
CN 11 subclavian arteryEJVbrachial plexus trunks
61
Paget-Schroetter syndrome
Exercise induced thrombosis of subclavian/axillary VEINTx- catheter directed thrombolysis
62
NEC
Bloody stools after 1st feeddx- pneumatosistx- resuscitation, abx; OR if free air, clinical deterioration
63
Fibroadenoma
cyclical paindx- US guided core bxonly excise if discordance with biopsy!
64
Pancuronium
non-depoleliminated by kidney and liver
65
Location of superior sympathetic block
3 to 5 cm in length on the longus capitus muscle anterior to the transverse process of the second, third, and rarely the fourth cervical vertebrae
66
Order of contents in thoracic outlet
vein (SC)phrenicmuscle (scalene)artery (SC)nerve (br plexus)
67
Insulinoma
Loc: throughoutPx: whipple's triadtx- < 2cm encucleate, >2cm resect
68
GCS verbal
5- normal4- confused3- inappropriate words2- incomprehensible1- none
69
Plasmin
Degrades f5, 8, fibrinogen, and fibrin
70
TXA2
vasoconstrictorsreleased by PLTs
71
Pseudocyst
encapsulatedlack epithelial lining>5cm requires drainage
72
Sevoflurane
fast, less laryngospasm, less pungentgood for mask induction
73
Fibrin
Links Gp2b/3a to form PLT plug
74
NOAC reversak
Dabigatran (pradaxa)- Idarucizumab, iHDApixaban- PCC (partial)Rivoroxaban- PCC (partial)
75
Indications for post op radio-iodine
2-4 cmvascular invasionanti-Tg AbTG<5
76
PEAK and TROUGH
PEAK- amountTROUGH- frequency
77
Desmoid tumor
Locally aggressive with no portential for metsTx with resection and chemo
78
MC vitamind def after REY GB
B12
79
Ulcers:MarginalCameronMarjolin ulcerCushing's ulcer
Marginal- REYGB at GJ anastomosisCameron- on lesser curve of large hiatal herniaMarjolin ulcer- chronic woundCushing's ulcer- elevated ICP
80
Products of posterior pituitary
"PAO in the POST"ADH, Oxytocin2/2 direct stem from neurosecretory cell
81
Stage 3 breast cancer and tx
3a- 4 to 9 nodes --> consider neoadj for BCT3b- chest wall (not pec wall) or breast skin --> neoadj required3c- supra clavicular nodes --> neoadj required
82
Tx of GIST
Resection w/ gross marginNo LN dissectionAdd imatinib (TK inhibitor) if >5m/50HPF
83
Non-cyanotic heart defects
ASDVSDcoarctation
84
Bevacizumab
recombinant humanized monoclonal antibody that blocks angiogenesis by inhibiting VEGF-A
85
c/i to BCT
multicentricinflammatory cac/i to radiation
86
AT3 Functions
Inhibits thrombin2. Inhibits f9, 10, 11
87
Ranson's criteria on admission
"GA Law" Glu > 200 age > 55 LDH > 350 AST > 250 WBC > 16
88
Cholangiocarcinoma types
1- below confluence2- at confluence3- R or L hep duct4- R and L hep duct5- multicentric
89
Glycogen
stores depleted after 24-48h of starvationMOST found in skeletal muscle, rest in the liver
90
Types of esophogectomy
Transhiatal- laparotomy and cervical incision/anastIvor Lewis- thoracic incisions/anast
91
type 3 choledochocal cyst
choledochoceletx- transduodenal marsupialization or excision
92
Treatment of colo-cutaenous fistula
Start with conservative tx High output: > 500 cc/day --> likely OR Low Output: < 200 cc/dayt --> likely conservative OR if failed after about 6 weeks
93
CPP
MAP - ICPnormal CPP > 60Normal ICP < 20hyperventilation to 35 decreases CO2 causing vascoconstriction and decreasing ICP
94
Accessible nodal stations w/ EBUS
2, 3, 4, 7, 10, 11, 12
95
tx of Meckels
tx- resection if sxs. if appendicits leave Meckel's alone If no appendicitis take out the Meckel'sOnly consider taking out incidentally found asx Meckel's in young/healthy ptif bleeding, inflamed or tumor at base --> segmental resection
96
Hypocalcemia
tinglingchvostek/trousseau signEKG- qt prolongation
97
Angiodysplasia of the colon
2nd MC CO gi bleed (vs. div's)Usually found in cecum and ascending colon
98
Effective for enteroccous
Ampicillin/AmoxacillinVancomycinTimentin/Zosyn(Resistant to all cephalosporins)
99
Lateral to medial femoral anatomy
Femoral nerveFemoral arteryFemoral veinEmpty space (hernia)Lacunar ligamentSuperficial ring
100
Gastrin
G cells of antrum signal EC cells --> His --> Parietal cell --> HClStimulated by ACh, beta ago, AA
101
Tx for gallstone ileus
Stable and healthy- stone removal and take down fistulaUnstable- stone removal only!
102
septic shock
high CI, low SVR, +/- wedge
103
Normal SBP in a neonate
60-90
104
How to reach D2 during EGD
right rotation and manipulate the up/down control knob
105
S/e of tamoxifen
dvt/peuterine cancer
106
Best test for resectability and staging of eso cancer
Resectability- ctStaging- US
107
Specific to UC
Crypt abscessPsuedopolyps
108
LeFort fxs
I- palateII- nose and palateIII- entire face
109
Epoteitn
stimulated by HYPOXIA produced by kidney fibroblastsLiver is major producer of EPO in fetus
110
Cutoff for low risk lung nodules not requiring follow-up
6mm
111
Best opioid to use for AKI
methadone and fentanyl/sufentanil hydromorphone or oxycodone are used with cautionmorphine and codeine are avoided
112
Anti-staph Penicillins
OxacillinMethicillinNafcillin
113
Bile concentration
Sodium chloride channels actively transport salt across the epithelium efficiently and water follows passively in response to the resultant osmotic force
114
Warthin tumor/Papillary cystadenoma
benign tumor of salivary glandoften BILATERAL and 2/2 smokingTx- complete resection with uninvolved margins even if ASx
115
Hurthle cell
Usually benignMUST do lobectomy to diagnosetx- total thyroid if malignant. XRT effective.
116
Neostigmine
reversal of non-depol muscle relaxantsAChE inhibitor
117
Imaging associated with benign adrenal mass
< 10HURapid washout< 4cm
118
ITP
px- petechiae and megakaryotcytestx- steroids (IVIG 2nd line) do not tx unless PLT < 30k or 20k in low risk
119
Paired vs. unparied t test
Paired- compares study subjects at 2 different times (paired observations of the same subject)Unparied- compares two different subjects
120
Respiratory quotient
CO2 produced / O2 consumed>1 → carb is major nutrient.7 → lipids major nutrient
121
Absolute c/i to spinal anesthesia
Infection at the siteHypovolemiaAllergyIncreased ICP
122
Parkland formula
4 x weight x TBSA 1st 1/2 in 1st 8h2nd half next 16
123
Steps of rapid sequence intubation
c-spine stabilize → preO2 → fentanyl → etomidate → succinylcholine
124
Where to find superior and inferior PD during a whipple
Superior: pancreatic headInferior: uncinate process
125
Tx of Barrett's
low grade dysplasia: repeat scope/bx in 6mhigh grade dysplasia: endoscopic mucosal resection
126
cyclosporine
MOA: calcineurin inhibitors/e- 100x less potent then tacro, nephrotoxic, hypertrichosis, gum hyperplasia
127
Effective for VRE
SynercidLinezolid
128
Kaposi's sarcoma
HSV8Violet/brown papules
129
T and N staging eso cancer
t1a- LP and MM t1b- SM t2- MP t3- adventitia t4a- resectable structures t4b- unresectable structuresn1: 1-2 nodesn2: 3-6 nodesn3: 7+
130
CRC T and N
t1- SMt2- MPt3- xMP/subserosat4- invaden1- 1-3, n2- >=4
131
Triple therapy
PP1 + 2 antibioticsabxs: amoxicillin, metronidazole, tetracycline, clarithromycin
132
Chole docho in REY bypass pt
w/ GB --> lap chole with CBD exploration --> ERCP through remnant stomachw/out GB --> ERCP with double balloon endoscopt --> ERCP throught remnant stomach
133
bile salt circulation
conjugate in hepatocytes into gly/taurine secreted into bile 80% reabsorbed in ileuim ACTIVELY 20% DECONJUGATED by bacteria deconjugated salts absorbed in colon PASSIVELY 6. 5% is excreted
134
Howship-Romburg Sign
Pain in medial thigh with internal rotation and extensionSuggests an obtruator hernia
135
MS vs. ED
MS- Fibrillin defect (elastin); AD, tall, aortic root dilation, lens defect, arachnodactylyED- t1, t3 , t5 collagen defect; hyper elastic skin, hypermobile joints
136
Most abundant bacteria in the colon
Bacteroides fragiles
137
Liver lesions on arterial phase: HCC Mets Adenoma Hemangioma FNH
HCC- Homogeneous enhancement Mets- Hypoattenuation Adenoma- Heterogeneous enhancement Hemangioma- Periph enhancing FNH- Centrifugal enhancing
138
Number of lung segments
R-10L-8
139
confounding
a variable that influences both the dependent variable and independent variable causing a spurious association
140
Epidural hematoma
BiconvexMMADOES NOT suture lines
141
Bethesda criteria for thyroid
10 mm is cutoff to get an FNA Non-diagnostic → repeat FNA Benign → follow-up Undetermined significance → repeat FNA Suspicious for follicular neoplasm → lobectomy, repeat FNA, or genetic testing (no core needle) Suspicious for malignancy → lobectomy vs. thyroidectomy Malignant → thyroidectomy
142
Effective for P/A/S
Ticarcillin (+ticarcillin), Piperacillin (+Zosyn)3/4G cephalosporin (ceftriaxone, cefepime)Aminoglycodies (genta, tobra)FlouroquinolonesMeropenem/Imipenem
143
HNPCC and criteria
HNPCC pts who fulfill Amsterdam clinical criteria for Lynch syndromeCriteria: 3 relatives (one 1st deg) w/ Lynch syndrome-associated cancer (CRC, endometrial, small bowel, ureter/renal) 2 successive generations 1 < 50 yo
144
MALT lymphoma
associated w/ h. Pylori.Tx: Low grade: triple therapy High grade: chemo and XRT (CHOP) +/- rituximab
145
MCCO chylous ascites
malignancy
146
Gastroschisis
GastRoschisis to the Right of midlinerare defects...EXCEPTION- instestinal atResia
147
Tx of AT3 def
Heparin does not work!Tx- recombinant at3 or FFP followed by heparin then warfarin
148
Indications to tx ICA stenosis
if Asx, only tx if > 60if sx, tx if > 50sxs- contralateral motor/sensory sxs, ipsi vision sxs
149
STSG vs. FTSG
STSG- epi + part dermis; worse cosmesis; more contracture! (don't use over joints)FTSG- epi + dermis; lower survival; more resistant; hypertrophic scar formation; more sensation
150
ASA
irreversible inhibitor of PG metabolism in PLTs2/2 cox acetylation7-days of PLT dysfunction
151
Tx for beta blocker overdose
glucagon
152
Products of anterior pituitary
TSH, ACTH, FSH/LH, GH, Proneurosecretory cell stimulates hypothalamus which lets go of releasing hormone
153
Rapid coumadin reversal
PCC
154
Pyoderma gangrenosum
associated w/ IBDRESOLVES after resectionpre-tibialtx- steroids
155
Central cord syndrome
loss of pain, temp, motormotor UE> LE loss (vs. anterior syndrome)
156
Scope schedule after Crohn's dx
10 years after dx then every year to r/o dysplasia
157
TNFa
produced by macrophagescauses cachexia
158
Beckwith Wiedmann Syndrome
3m-2yAssociated with hepatoblastoma and wilm's tumor
159
type 1 choledochocal cyst
fusiform dilationtx- excision w/ REY H-J
160
Cryo
vWF, f8, fibrinogen
161
Breslow depth
t1: < 1mm → .5-1 cm margint2: 1-2 mm → 1-2 cm margint3: > 2 mm → 2 cm margin
162
Best test to dx gastroparesis
Scintigraphic gastric emptying
163
Atlanta classification pancreatits
1. Interstitial: <4w- acute peripanc collection, >4w psuedocyst2. Necrotic: <4w- acute necrotic collection >4w- walled of necrosis
164
FFP
All factors, Protein C and S, AT3
165
Child's Pugh Score
Billirubin, Albumin, INR, Ascites, Encephalopathy
166
ARDS ratio
P/F mild- 200 to 300 moderate 100-200 severe < 100
167
Orientation of portal triad
Bile duct lateralHepatic artery medialPortal vein posterior
168
Schiatzki's Ring
Associated with hiatal herniaTx- only if sxatic. dilation and PPI; do not resect
169
MOA reglan and erythromcyin
reglan: dopamine antagonisterythromycin: motlin receptor agonist causing SM contraction
170
indications to bx a neck mass
confirm FNA or core needle with excisional biopsy! >1.5 cm enlarged node without signs of infection persistence after trial of antibiotics and observation >2-4 wks increasing size of mass
171
Peri-op anti-PLT agents
Clopidogrel (plavix): hold 5-7 days before elective surgeryASA: continue through the surgery
172
neurogenic shock
high CI, low SVR, low wedge
173
Indications for iHD
GFR 10-15 for sxaticGFR < 5 for asymptomaticSxs = AEIOU (acid, lytes, intox, olverload, uremia)
174
Breast Cancer in pregnancy
1T- MRM. Chemo is not OK. 2T/3T- consider BCT. Modfied radio-isotope. Chemo is OK. Post delivery radiation.
175
Who needs stress dose steroids
>20 mg of steroids for > 3 weeks
176
Frey syndrome
gustatory sweating s/p parotidectomy
177
Layers of colon/rectum
1. mucosa2. sub-mucosa3. muscularis propria4. serosa
178
FNH
path- CENTRAL STELLATE SCAR!; bright on arterial phase homogenoustx- resect if sxatic. no malignant potential.
179
TOF
Most common cyanotic defectVSD, PS, OA, RVHtx- beta blocker; surgery at 3-6m
180
Omphalocele
2/2 failure of umbo ring closure 11th week gut returns to abdominal cavitynormal bowel (protected)Other congenital defect are more common
181
Hard signs of vascular injury
shockexpanding hematomapulsatile bleedthrill/bruitabsent pulseischemia
182
Primary lymphoid organ vs. secondary
Primary: generate cells i.e. liver, bone, thymusSecondary: maintain cells i.e. nodes, spleen, MALT
183
Tx of liver lesions:HemangiomaFNHAdenoma
Hemangioma: only if sxatic or KM syndrome FNH: NTD Adenoma: < 4cm w/out OCP response or > 4cm
184
s/e of silver nitrate, silver sulfadiazene, mafenide
Silver nitrate- eletrolytes disturbace (no sulfa)Silver sulfadizene- neutropenia, sulfaMafenide- met acidosis, sulfa
185
Tx of complete CBD transection
REY HJ has better long term outcome than primary repair
186
Indications for neoadjuvant therapy for stomach cancer
Any T2 lesion or LN involvementT2: growth into the muscularis propria
187
Number of LN needed for gastric vs. CRC
gastric- 15CRC- 12
188
Thyroid ima
supplies medial aspect of both lobes of the thyroidcome off the innominate/brachiocephalic
189
long chain vs. medium chain TG
LC- absorbed by lymphaticsMC- absorbed into blood
190
Fuel for SB and LB
SB- glutamineLB- SCFA
191
Torsades
2/2 hypoK, hypoCa, hypoMgall cause qt prolongation
192
Carcinoid vs. GIST origin and tx
carcinoid- Kulchinsky cells (enterochromaffin-like) < 2cm --> appendectomy > 2cm --> R hemi chemo if unresectable GIST- cajal cells tx- resection imantinib
193
Thoracic duct course
originates at L1-L2 @ c. chylicross from R to L at T4-5empties into L SC/IJ jxn
194
TOF anomalies
Over-riding aorta RV hypertrophy VSD RV obstruction
195
Sevoflurane
rapid induction, less laryngospasm, less pungentgood for mask inductions/e- expensive, liver metabolism
196
Inidications for neoadjuvant chemotherapy for rectal cancer
Stage 2 and aboveStage 2: at least t3 (crossing musc prop) or any n (stage 3)
197
Screening guidelines for breast ca
annual screening at age 40
198
DDAVP
Cause endothelium to release f8 and vWF
199
Iron def
anemia, glossitis, brittle nails, cardiomegaly
200
Types of vagotomy
Highly selective: only removes innervation to lesser curvature- preserves pylorus → no drainage procedureTruncal vagotomy: removes lesser curve and pylorus nerves (upstream)- need pyloroplasty. high r/o dumping syndrome
201
Vitamin K
gamma CARBOXYLATION (not decarb) of GLUTAMATE on 2, 7, 9, 10, c, s
202
Spigelian hernia
found along semilunar line lateral to rectusall should be repaired
203
Ethylene glycol toxicity
metabolized in the liveroxalate stones → renal failureanion gap met acid
204
type 4 choledochocal cyst
extra/intra dilationstx- excision w/ REH H-J
205
Hyperacute rejection mechanism
Host IgG towards class 1 MHC
206
PPV, NPV
PPV = of the people who test positive how many have the diseaseNPV = of the people who test negative how many do not have the disease
207
Isoflurane
good for neurosurgery; no increase in ICP
208
Indications for neoadjuvant therapy eso cancer
t1b and above ORany nodal involvement
209
MCCO healthcare infection: HAP central line infection SSI UTI GI infection
HAP: staph central line infection- candida SSI- staph UTI- e. Coli GI infection- c. diff
210
Peutz-Jeghers
ADPx- intestinal hamartomas, pigmented oral mucosaStart screening at 25; scope q2 years
211
T and N staging for gastric cancer
t1- SMt2- MPt3- xMP/subserosat4- invaden1: 1-2, n2: 3-6, n3: >7
212
MC uni-microbial CO nec fasc
Clostridium perfringensgas gangreneanaerobic
213
Calcitonin
Parafollicular C cells Inhibits osteoclast resorptionIncreases Ph excretion
214
Halothane
Slow onset/offset.Least pungent (children)s/e:- highest cards depression and arrhythmia- halothane hepatitis
215
types of endoleak and tx
1- proximal or distal seal --> emergent!2- back bleeding3- graft defect (tear or overlap leak) --> emergent!4- porosity
216
ASD
L to R shuntOstium primum (down syndrome) and secundumParadoxical emboliRepair at 1-2y
217
Atropine
competitive inhibitor of ACh at muscarinic receptor liver metabolism
218
Zinc def
skin rash, impaired wound healing, testicular atrophy
219
Hepatitis seromarkers
Vaccinated: surface Ab POSITIVEResolved Hb infection: surface Ab POSITIVE and core Ab POSITIVEActive infection: surface Ag, surface Ab, and core Ab ALL POSITIVE
220
MCCO Cancer
Male- prostate, lung, CRC lung, prostate, CRCWomen- breast, lung , CRC death: lung, breast, CRC
221
Hereditary pancreatitis
PRSS1 trypsinogen mut'nADsmoking cessation is important
222
type 2 choledochocal cyst
cystic diverticulatx- excision w/ primary closure (NOT a REY)
223
Reversals: BB Tylenol Benzos CN/Nitroprusside Vecuronium/Rocuronium Ethylene glycol Methemoglobinemia
BB overdose: fluids/atropine → glucagon Tylenol: NAC Benzos: flumazenil CN/Nitroprusside: sodium thiosulfate, amyl nitrite Vecuronium/Rocuronium: sugammadex Ethylene glycol: femopizole and bicarb OR ethanol; iHD Methemoglobinemia: methylene blue
224
TASC classifcation
TASC a and b usually get endovascular repairA- < 3cmB- 3-10 cm
225
Superior laryngeal nerve
motor to cricothyroidinjury: high pitch
226
Lipopolysaccharide
cell wall of GN bacteria endotoxinactivates complements cascade → sepsis
227
Tylenol metabolsim
Glucuronidation (45-55%) Sulfation (sulfate conjugation) (20–30%) N-hydroxylation and dehydration, then glutathione conjugation, (less than 15%) hepatic cytochrome P450 enzyme system NAPQI
228
F5 Leiden
resistance to protein C and Sacts w/ Xa to converts fibrinogen to fibrin
229
Paget Von Schroetter syndrome
narrowing of SC/Ax vein 2/2 mech compressionpx- acute swellingTx- catheter directed thrombolysis (NOT open thrombectomy)
230
Lung fissures
Oblique fissure: aka major fissure; separates upper lobe from lower lobe +/- middleHorizontal fissure: aka minor fissure; only on the R; separates upper lobe from middle lobe
231
Treatment of Merkel Cell
excisionhighly radiosensitive. radiate if > 2cmSLNBx
232
Mucoepidermoid carcinoma
MC malignant H/N tumor
233
Staging GB cancer
1a- LP --> just cc'ectomy1b- MM --> cc'ectomy, hepatic/ LN/duct resectiont2- perimuscular CTt3- organs
234
Copper def
pancytopenia, myelopathy, pigmentation change
235
CRC staging
stage 1- t1 to t2, n0stage 2- t3 to t4, n0stage 3- node involvementstage 4- m1
236
sirolimus
MOA: mTOR inhibitors/e- lymphocele, wound complications- lymphcele can cause mesenteric mass and SBObenefit- less nephrotoxic
237
DES
unorganized peristalisisnormal LES pressurenormal relaxation
238
Selenium def
cardiomyopathy, hypothyroid
239
Clinical trial phase
1- determine safe dosing and route2- evaluate effectiveness and side effects3- determine if better than alternatives4- follow individuals for s/e's
240
Echinoccocus
Hydatid cysttx w/ mebendazole
241
Heparin
accelerates AT3 activity and INDIRECTLY inhibits thrombin
242
hepatic adenoma
path- EARLY HETEROGENEOUS enhancement on A phase w/ rapid washouttx- stop OCP use. resect if > 5cm or sxatic
243
Specific to Crohn's disease
CobblestoningGranulomasTransmural Fistulas
244
Free water deficit
TBW x [(Na-140)/140]TBW = weight x .6 (men) or .5 (women)
245
Spinal vs. Epidural
Spinal- below l1/l2; SA space; fast; n/m blockEpidural- any level; epidural space; slow; no block
246
Tx SIADH
Chronic – Tx: fluid restriction and diuresisAcute – Tx: conivaptan, tolvaptan
247
Rocuronium
non-depolrapid onset; best for short procedureseliminated by liver only
248
type 1 vs. type 2 error
type 1: false positivetype 2: false negativepower = 1 - type2
249
Periop DM management
Oral agents: hold ON THE MORNING of surgery. Resume after surgery (EXCEPT for metformin)Rapid IV agents: withhold while NPO and use with a sliding scaleIntermediate/Long acting: give normal dose the night before Give ½ dose the morning of surgeryPump: keep a basal insulin infusion on the day of surgery - use pump to correct levels as needed
250
T staging indications for neoadjuvant- eso- stomach- colon- rectal
- eso: t1b (SM)- stomach: t2 (MP)- colon: t4b (adjacent organs)- rectal: t3 (through MP)
251
Ureter injuries
proximal ⅓ → primary ureterourostomymiddle ⅓ → primary or tran uretero urosotomylower ⅓ → re-implanation +/- hitch
252
Hot vs. cold nodules
Hot- surgery or iodine ablation --> unlikely cancerCold- FNA --> may be cancer
253
Post splenectomy ppx
"SHiN"PPV23 + haemophilus influenzae TYPE B + meningococcal polysaccharideElectively- 2 weeks beforeEmergently- PPV23 directly postop, other two given 2 w post op
254
Milan criteria
indications for trx w/ HCC Single tumor < 5cm No more than 3 tumors each < 3 cm5-year transplant pt survival is 65-90%
255
Isoflurane
Good for neurosurgeryPungent (not used for induction)
256
Hyperkalemia EKG
peaked T wave
257
Dexmedetomidine
Mech- CNS alpha2 agoNot an induction agent. Good for intubated ptsAnesthesia and analgesias/e- bradycardia
258
MC aortic infections
aneurysmal- staphnon-aneurysm- salmonella
259
febrile transfusion rxn
RECIPIENTS Ab attack DONOR leukocytes
260
Tx of breast CA in preg
partial mastectomy + radiation after preg OR full mastectomytrastuzumab is c/i
261
Octreotide
Somatostatin analogueInhibits exocrine function of pancreas and CCK releaseTx for chronic pancreatitis
262
Latent error
2/2 condition of system being removedevident after a “perfect storm”
263
Specific to Crohn's
Creeping fatSkip lesionsTransmural
264
Polyps that require surgery instead of endoscopic resection
Submucosal invasion > 1mmPoorly differentiated<1 mm marginLymphovascular invasionTumor buddingSessile polyp (if you can't get it all)
265
Blood supply of pancreas
Head: superior PD and inferior PDBody/tail: splenic
266
Mondor disease
tender, “cord-like” structuretx- NSAIDs
267
Criteria for transanal excision of adenocarcinoma
T0 or T1 (submucosa)< 3 cm< 30% circumferencePalpable on DRE (<8cm from anal verge)
268
Meckel's Diverticulum
Anti-mesenteric border of SB2/2 peristant viteline ductpancreatic and gastric tissue
269
Acetazolamide
Inhbitis carbonic anhydraseInterferes with bicarb resorbtion causing non-AG metabolic acidosis
270
hypovolemic shock
low CI, high SVR, low wedge
271
Tx for hemobilia
angioembolization
272
PFTs for lung resection
FEV1 >1.5L lobe, >2L pneumo --> OK for surgeryIf not: lung scanPPO FEV1 > .8L (>40%)PPO DLCO > 10 ml/min/mmHg (>40%)If not: exercise testVO2 > 10 ml/min/kg --> OK for surgery
273
Succinylcholine
ONLY depolarizingshort half life and rapid onset (RSI)degraded by plasma CEs/e: rhabdo, ocular HTN, malig hyperthermia, hyperKc/i: spinal cord injury, renal failure, large burns
274
dcis vs. lcis
dcis: excisional bx 1mm margin no SLN unless mastectomy lcis: excisional bx margin for LCIS --> no further intervention. consider hormone tx or ppx mastectomy margin positive for DCIS/invasive ca --> surgery
275
Sarcoma T and N staging
T1- <5 cmT2- > 5cmN1- regional nodes
276
Etomidate
Fewer hemodynamic changesFast actingFewest cards s/es/e- adrenocortical suppresion w/ cont infusion
277
basiliximab
MOA: IL2 inhibitor
278
Midodrine
a1 agonist
279
Li Fraumeni
p53 mutationbreast ca + soft tissue sarcoma
280
Tx of Ogilvie's
supportive, dc narcotics, ng tube, neostigmineif > 10cm --> scope decompression and neostimgine failure --> OR
281
MCCO cauti
1. e. coli2. enterococcus3. candida
282
cardiogenic
low CI, high SVR, high wedge
283
GCS eye opening
4- spon3- to voice2- to pain1- none
284
Dysplasia of any grade in the GI tract
polypectomy will sufficeneed to re-scope in 3m if high grade or sessileif there is SM invasion --> surgical resection
285
Markers:Ca 125bHCGAFPInhibin
Ca 125- epithelialbHCG- choriocarcinomaAFP- germ cell/endodermal/yolk sacInhibin- granulosa/sex-cord
286
Inguinal hernia nerves
Ilioinguinal- MC in open repair; runs ant/top of cord; under EOIliohypogastricGB of GFLateral femoral cutaneous- MC in lap repair; injured laterally
287
Axis of gastric volvulus
Organoaxial: rotate around the long/vertical axis Mesenteroaxial: rotate around wide/horizontal axis
288
neostigmine
MOA: increased PS activity (AChE-I)tx for ogilvie'sMONITORED SETTING w/ atropine b/c high r/o BRADYCARDIAb4 r/o mech obsxn 1st or r/o perf b/c of enhanced motility and pressure
289
Somatostatinoma
Loc: headPx: DM, gallstones, steatorrhea, block exo/endo pancreas
290
Tx of prolactinoma
if sxatic or macroadenoma bromocriptine or carbegoline (both dopa agonists) bromo is safe in pregnancysurgery if failure
291
Sub-acute thyroiditis
Recent viral URI tx- NSAIDs/steroids
292
Variceal bleeding 2/2 pancreatits
Splenic vein thrombosistx- splenectomy
293
VW disease
1- low quantity. tx- desmo and cryo2- low quality: tx- only cryo3- complete absence: tx- cryo and desmodx- ristocetin test or measure vWF level
294
Loss in excess weight for each surgery
REYGB- 75%SG- 60%Lap band- 50%
295
Gastric ulcers
1- lesser curve/antrum; normal acid2- gastric + duo; high acid3- pre pyloric: high acid4- GE junction: normal acid
296
Modified radical mastectomy
mastectomy with ALND (level 1 and 2 only) w/ sparing of pectoralis
297
layers of the eso
Mucosa epithelium LP MM Sub-mucosa (lots of lyphatics!) MP AdventitiaNO serosa!
298
Duration of treatment - tamoxifen and trastuzumab
Tamoxifen- 5yTrastuzumab- 1y
299
F11 def
r/o bleeding w/ surgerytx- FFP (not f11 concentrate!)
300
Margin for LE sarcoma
2cm
301
Somatostatin
D cells in stomach, duo and pancShuts off insulin, glucagon, and gastrinStimulated by acid
302
Stimulation of CCK release
fatty acids and amino acids in the chyme entering the duodenumCCK-releasing proteinACh
303
Order of potency of steroids
HC Pred Methylpred Dexameth
304
Cowden's
pten mutationbreast ca + thyroid ca + hamartomas
305
long thoracic nerve vs. thoracodorsal nerve
LTN → serratus --> winged scapTD → LD --> difficult shoulder ADduction/Int rotation
306
PLT count trx threhold
Stable and non-bleeding --> < 10K Stable and non-bleeding with temp > 38 --> < 20kSurgical pt < 50k <20K spontaneous bleeds
307
NNT`
NNT = 1/absolute risk reduction (ARR)ARR = event rate in intervention group - rate in null group
308
half-life acoags:warhepnoac
war - 36hhep 90mnoac- 12h3.5 half lives to ss
309
Achalasia
no peristalsishigh LES pressureincomplete relaxation
310
MEN syndromes
1- panc, pit, PT2a- PT, MTC, pheo2b- pheo, MTC, marfanoid/neuromas
311
Tx of cholangiocarcinoma
1. Upper 3rd- duct resection w/ partial hepatectomy2. Middle 3rd- bile duct resection + LADN3. Lower 3rd- Whipple*Locally advanced/unresectable- transplant
312
Types of Shunts
Total: porto-caval, meso-caval
- Relieves bleeding and ascites More hepatic encephalopathy
- Relives bleeding only
313
Glucagonoma
Loc: distalPx: dermatitis, DRH, DM, nec mig erythema
314
MELD
Bili INR Creatinine
315
Pancreatic ducts
Wirsung- major, lies inferiorSantorini- minor, lies superior
316
Hypokalemia EKG
qt prolongation
317
Entamoeba histo
MExicotx with MEtronidazole (no OR!)NO rim enhancement (vs. amoebic abscess)dx- EIA (assay)
318
Group A strep
strep pyogenessuspect if gas and bullae
319
Imatinib
competitive inhibitor of TKtx for GIST
320
Tx of ovarian vein thrombosis
AnticoagulationAbx if septic sxs
321
Pyogenic abscess
MC- biliary dz and bile obstruction; e. Coli and klebtx- perc drainage is 1st line!
322
clostridium
anaerobic, GPRMC CO emphysematous cholecystitisMC CO gas gangrenetx- PCN, clinda 2nd line
323
Light's criteria
PL protein/serum Pr >.5 PL LDH/serum LDH > .6 PL LDH > 2/3 ULN
324
Tx of psuedocyst
<6cm and <6w --> conservative>6cm and >6w --> drain if sxatic (perc cath, endoscopic methods, or surgery)
325
Arterial content
(1.34 x Hb x Sa02) + (.003 x PaO2)
326
tx of eso cancer by t stage
t1a- mucosal resectiont1b- esophagectomyt2- esophagectomyt3- esophagectomyt4a- esophagectomyt4b- chemo/radscervical- chemo/rads
327
FAP screening and treatment
Scopes annually starting at 10-12y life-long screening for APC carriers. Can stop at 40 if not APC carrierIndications for colectomy Suspected colorectal cancer Severe symptoms High-grade dysplasia Multiple adenomas larger than 6 mm Marked increases in polyp number on consecutive exams Inability to adequately survey the colon because of multiple diminutive polyps
328
Stewart-Treves syndrome
post mastectomy lymphangiosarcomarare and highly malignantTx- wide local excision w/ 3-6 cm margin
329
Fibrinogen
binds gp2b/3a receptors to link PLTs together
330
Ranson's criteria at 48 h
"C and Hobbs" Ca < 8 HCT down > 10 pts O2 < 60 Base deficit > 4 BUN > 5 Sequestration of fluids > 6L
331
Hemangioma
path- PERIPHERAL ENHANCEMENTtx- if rupture, size change, or KM syndrome
332
Drainage of gonadal veins
R- IVCL- L renal vein
333
T staging for HCC
T1: any size without vascular invasionT2: < 5 cm with vascular invasionT3: > 5 cm with vascular invasionT4: invade adjacent organs
334
Indications of breast MRI
high risk women occult breast cancer
335
T staging for esophageal cancer
t1a- muscularis mucosat1b- SMt2- muscularis propriat3- adventitia*no serosa
336
Halothane
cheapesteffective at low concentrations/e- ventricular arrhythmia, hepatic necrosis
337
Stress induced gastritis
Stress elevated AChACh --> parietal cells --> ATPase H+ secretion
338
Grading of splenic injury
1- <1 cm,2- 1-5 cm,3- > 5cm,4- segment/hilar vessels,5- shatteredReturn to activity → injury grade + 2; so grade 2 would be 4 weeks
339
Tx of Zenkers
<2cm: circopharyngeal myotomy2-5 cm: myotomy +/- diverticulectomy>5cm: myotomy + diverticulectomy
340
Liver collection txPyo-Amoebic-Echino-
Pyogenic- drain and abxAmoebic- metronidazoleEchinococcal- albendazole and resect
341
AT3 def
ADnon-vit K dependent protease for 10a potentiated by heparintx- FFP
342
Fibrolamellar HCC
well circumscribed w/ central scar similar to FNHnormal AFP and elevated neurotensin (Vs. FNH)
343
Warfarin
competitive inhibitor of epoxide reductase (vit K activator)
344
Human bite tx
amox/clavulanate (augmentin)MC for human bites- eikenella
345
Variceal bleeding after distal pancreatectomy
Gastric varices
346
NNT
1/ARRARR = risk w/ tx - risk w/ placebo
347
Surveilance schedule for FAP, HNPCC
FAP- start at 10HNPCC- start at 20
348
preA vs. Albumin
Prealbumin: t1/2 is 1-2 days; best marker for short-term nutritional statusAlbumin: t1/2 is 21 days; biomarker of long term nutrition; pre op assessment
349
Cause of:gravesTMNHashimoto'sDeQuervains
graves- IgG against TSHrTMN- hyperplasia 2/2 low grade TSH stimulationHashimoto's- antiTG abs (cell-med and humoral)DeQuervains- viral URI
350
Mechanical valve periop
restart coumadin in 12-24h and bridge w/ heparin or lovenox
351
Vitamin D processing
7-DHC + sunlight --> d3liver --> 25-d3kindey --> 1,25-d3
352
Requirements for lung surgery
- FEV1 > 1.5L (lobectomy), > 2L pneumonectomy- pppo FEV1 > 40%- ppo DLCO > 40%- VO2max > 15
353
TRAM flap
SUPERIOR epigastric arterycan use ipsi or contra muscle
354
Normal values: CVP, WP, SVR, CI
CVP 2-6WP 4-12SVR 700-1500CI 2.5-4
355
Loop diuretics vs. Ca sparing diuretics
loop- furosemideCa sparing- thiazides
356
Indications for chemo with breast cancer
> 1cmCx positive nodesTriple negativePoor oncotype
357
TLV
TLV = RV + ERV + TV + IRVFRC = RV + ERVIC = TV + IRV
358
VIPoma
Loc: distalPx: watery DRH, hypoK, achlorhydria, inhibits gastrin
359
Types of rejection
hyperacute- preformed IgG against donor; t2HSacute- T and B cell resposne to MHC; t4HSgraft vs. host- graft T-cells attach host; t4HS
360
Neoinitmal hyperplasia
proliferation and migration of vascular smooth muscle cells primarily in the tunica intima, resulting in the thickening of arterial walls and decreased arterial lumen space. cause of restonisis after CEA
361
Benign lesions that require excisional bx
Atypical DH/LH LCIS/DCIS radial scar papillary lesion any atypia
362
MC nerve injury Br/Bac fistula
medial brachial cutaneous n.
363
Pyloric stenosis
px- hypochloremic, hypokalemic metabolic alkalosisdx- UStx- pyloromyotomy
364
Treatment of SVT
Vagal maneuvers or adenosine
365
Fuel for colonocytes
SCFA (acetate, butyrate, propionate)
366
Tx for hyponatermia
Acute sxatic: hypertonic salineHypervolemia: hypertonic salineEuvolemic and asxatic: free water restrictionHypovolemic: volume resuscitate w/ LR or NS
367
Zone injuries
penetrating: zone 1-3 --> exploreblunt: zone1 --> explore zone 2-3 --> do not explore
368
Wiskott-Aldrich Syndrome
X-linkedTCPenia + combined b/t cell def + eczema
369
hot vs cold nodules
hot- surgery or iodine ablationcold- FNA
370
TTP
path- def in ADAMtS13px- TCP purpura, neuro sx, kidney dz, hemo anemia, fevertx- plasmapheresis → splenectomy if failed
371
Layers of mucosa
EpitheliumLamino PropriaMuscularis mucosa
372
What is not suppressed by high dose dexa
Adrenal massEctopic mass (small cell cancer)
373
MOA of tacro, cyclosporine, sirolimus, mmf, basiliximab
tacro- calcineurin inhibitorcyclosporine- calcineurin inhibitorsirolimus- mTor inhibitormmf- cell cycle inhibitorbasilixamab- il2 inhibitor
374
Enzymes secreted in their active form from pancreas
Amylase/LipaseRibonuclease/Deoxyribonuclease
375
Gastrinoma
Loc: gastrinoma triangle (CBD, panic neck, 3D)Px: refractory PUD, gastrin > 200 on sec stim test
376
dx of colovag and colovesic fistula
colovag: tampon testcolovesic: CT scan
377
SCIP guidelines
Ppx abx 1 hour before incision (vanc can be 2hr) DC abx 24h after end time 48h for cardiac surgery Cardiac pt should have glucose should be < 200 on POD1 and 2 Shaving is inappropriate; should clip hair Remove foley on POD1 or 2 Maintain normothermia (=> than 36) Recieve BB 1 day prior to surgery through POD2 VTE prophy within 24h of end time
378
Milrinone
PD inhibitorcontractility with vasodilationgreat for pulmonary hypertension
379
HNPCC inheritance - Amsterdam criteria
ADDefect in MLH/MSH 3x relatives 2x generations 1x < 50y
380
Richter's hernia
protrusion and/or strangulation of part of the intestine's anti-mesenteric border
381
Plasmin
degrades fibrin and fibrinogenactivated by urokinase and streptokinase
382
HNPCC screening and treatment
scope q1-2y starting at 20-25 Surgery if: CRC or endoscopically unresectable TAC with IRA and surveillance rectum prophylactic hysterectomy and BSO offered at the time of colectomy Other screens: Annual pelvic exam, endometrial bx, TVUS Upper endoscopy with bx of antrum. treatment of H. pylori infection Annual urinalysis Annual skin/neuro exams
383
Melanoma types
superficial spreading- MClentigo- sun exposed, best prognodular- worst prog
384
Replaced R and L hepatic
R- SMAL- left gastric
385
RQ of fat, carb, and protein
Carb = 1Protein = .8Fat = .7
386
RR vs. OR
RR: of those who were exposed how many got the dz/of those who were not exposed how many got the dz- considers total population. good for prospectiveOR: odds of exposure in cases / odds of exposure in controls(a/c) / (b/d)- good for retrospective
387
Encapsulate organisms
Strep pneumo (MC)NeisseriaHaemophilus
388
MMF
MOA: cell cycle inhibitor
389
Immunonutrients
GlutamineArginineOmega-3 FA
390
Gail model
ageage 1st periodage 1st birth1d relativeprevious bxrace
391
When to operate on adrenal mass
all functioning tumorsall > 6 cm --> open resection (no lap)if < 6cm with suspicious features (>10HU, slow w/out) --> open resection (no lap)if bilateral --> tx medically w/spironolactone
392
Origins of medullary thyroid cancer
4th pharyngeal arch releases NCC which form parafollicular C cells
393
Bile Acids
750 cc/day secretedPrimary bile acids- cholic, chenodeoxycholicSecondary bile acids- deoxycholic, lithocholicprimary bile acids produced by the liver then undergo deconjugation in the gut by bacteria.
394
Component separation
External oblique fascia
395
VHL
up regulation of vegfhyper vascular tumors
396
Felty syndrome
rheumatoid arthritis, splenomegaly, granulocytopenia
397
Merkel cell ca
rare neuroendocrine tumor of the skinlooks like BCC w/out rolled edgeshighly radiosensitiveTx- surgical excision + SLNBx + XRT
398
Aminocaproic acid
Plasmin inhibitor
Use: DIC, excess tpa
399
Secretin vs. CCK
Both released by duoS cells --> Secretin- duct cells --> bicarbI cells --> CCK- acinar cells --> enzymes
400
Nutcracker eso
high amplitude/long peristalsisnormal LES pressurenormal relaxation
401
Ectopic parathyroids
superior parathyroids is the tracheoesophageal groove and retroesophageal region.inferior parathyroids- anterior mediastinum, thymus, thyroid gland
402
421 rule for mIVF
4 ml/kg/hr for 1st 10 kg+2 for next 10-20+1 for every kg above 20
403
Inidications for non-op managemement of eso perf
early diagnosis or delayed diagnosis with contained leak not in the abdomen contained perforation in the mediastinum content of the perf drain back to the esophagus perforation does not involve neoplasm or obstruction of the esophagus absence of sepsis
404
Treatment of GB polyp
Sxatic --> resectHigh risk or > 6mm --> resectLow risk --> EUS> 18 mm --> open cholecystectomy, partial liver resection, and possible lymph node dissectionGallbladder polyps that are not resected should be followed-up with serial ultrasound examinations
405
Se, Sp
Sensitivity = of the people who have the disease how many test positiveSpecific = of the people who don’t have the disease how many test negative
406
z11 trial implications
If less than 3 nodes positive on SLN and T1 or T2 disease, BCT is OK
407
Splenic vein thrombosis
If variceal bleeding tx with splenectomy
408
Cervical neoplasia
CIN1- tx infection, close f/upCIN2- cryo or leepCIN3- cryo or leep
409
McVay repair
Hernia repair without meshApproximates TAA to cooper's ligament
410
GCS motor
6- obeys commands5- localized4- w/draws3- flexion (decort)2- extension (decerebrate)1- none
411
Minimum negative margin for BCC
4 mm for unaggressive8 mm for aggressive tumors
412
CO2 vs. NO2 for pneumoperitoneum
CO2 advantage- doesn't combust. less expensive. CO2 disadvantage- acidosis, long elimination, sympathomimetic
413
Mattox maneuver
"L --> Mattox"move left structures to the rightexposure left sided vasculatreexplore aorta and L renal vein
414
Propofol
Rapid distribution and on/offs/e- hypotension, resp depression, meta acidmetabolism- liver
415
Pancreas drainage procedures
Peustow- pancreaticojej (for large duct)Frey- pancreasticojej + core out headBerger- pancreatic head resection (for large head)
416
Recurrent laryngeal nerve
motor to larynx excluding circothryoidinjury: hoarsness, airway compromise
417
Cryo used to treat?
1. VWD2. Fibrinogen def3. Hemophilia A
418
Tx for DVT
unprovoked: no RF --> 3-6m acoagprovoked: RF --> 3mopen thrombectomy --> last resort for threatened limb loss secondary to extensive DVT and phlegmasia
419
Contents of FFP and Cryo
FFP: all clotting factors; f5 and 8 decrease over timeCryo: VWF, f8, fibrinogen
420
Ureter anatomy
Runs under the vas/uterine arteries Runs over the iliacs
421
Trauma to the pancreas
head- main duct: drain w/ staged resection- tail: draintail- main duct: drain- tail: resect w/ splenectomy (unless child)
422
Central venous O2 vs. mixed venous O2
Mixed venous: from PACentral venous: from SVC only (estimation of mixed)
423
Exposing the pancreas
Head: kocherize Body: incise gastrocolic ligament --> lesser sac Tail: mobilize spleen
424
Cuff size for kids
age/4 + 4
425
Crystalloid and colloid for trauma kids
Crystalloid: 20cc/kgPRBC: 10cc/kg
426
qSOFA score
AMS (<15)RR > 22SBP < 100
427
Nitrogen balance
Nitrogen Balance =Protein intake (grams)/6.25 - (UUN + 4 grams)UUN = grams of nitrogen excreted in the urine over a 24 hour period4 = stool and insensible losses
428
s/e of carb, protein, and lipid
carb- immunosuppression, resp failurelipid- pro inflammatoryprotein- false neurotransmitters, rise in ammonia/urea
429
Serum osm calculation
2xNa + Glu/18 + BUN/2.8
430
Corrected Ca
For every 1 drop in albumin below 4, serum Ca drops by .8
431
Acid/Base of Ng suctioning
HypoCl, HypoK metabolic alkLoose HCl and fluidTurn on RAA systemRetain Na/Excrete acid (paradoxic acidurea)
432
Acetazolamide
MOA: Ca inhibitorCauses kidneys to excrete bicarb causing a metabolic acidosis
433
Ileal conduit
Hyperchloremic metabolic acidosis(urine high in Cl is exchanged for bicarb which is excreted)
434
MC ST sarcoma and dx and tx
MC- malignant fibrous histiosarcoma then liposarcomadx- core needle then --> <4cm: excisional >4cm: long. incisionaltx- resection. post op xrt if > 5cm. pre op if > 10cm. doxorubicin.
435
Penecillins evolution
Penicillin: strep Methicillin, Oxacillin, Nafcillin: staph Ampicillin, Amoxacillin: enteroccocus Unasyn/Augmentin: GNRs (not psuedo) Ticarcilin/Piperazillin: pseudomonas
436
peri-op anti-PLT therapy in pt with stent/PCI
No CV dz: stop ASA 7-10 days before surgery. Restart after 24-72h depending on bleeding in surgery Known CV dz Elective surgery: delay surgery until after optimal time Emergent surgert: c/w DAPT unless high bleeding risk Dual antiplatelet therapy duration: post-pone elective operations two weeks after simple dilatation six weeks after bare-metal stents 12 months after drug-eluting stent
437
Acute cholangitis
Dx: U/S showing dilation > 7mm w/ jaundice, fever, RUQ painTx: Mild and responding to abx: ERCP w/in 72h Severe and non responding: ERCP w/in 24h
438
Relative c/i to componenet separation
Extensive destruction of the components of the abdominal wall Compromise of the superior epigastric artery and/or deep inferior epigastric artery, Contaminated operative field Smoking, COPD, DM, ascites
439
Stimulates pancreas from the jejunum
CCKSecreteinGIP
440
MYH gene
MYH associated polyposisAR!
441
Cryoptococcus vs. Coccidiomycosis
Crypto- CNS sxs in AIDs pt; tx- amphotericinCoccidio- pulm sxs in the southwest; tx- amphotericin
442
hypokalemia on EKG
ST depression.T wave inversionProminent U wavesLong QU interval
443
Rectal cancer work-up
complete scope: look for synch lesion CT CAP: mets T staging: rectal US (early stage), MRI (late stage)
444
REY GB with choledocho
Trans-gastric ERCPor double balloon endoscopy
445
dx of ischemic colitis
endoscopy (although CT should be your first test)
446
SIADH tx
acute- vaptanschronic- h2o restriction, diuresis
447
Breast abscess that fails to resolve after 2 weeks
Excisional bx to rule out inflammatory cancer
448
Sarcoma prognosis by grade
1-
449
Tx for ectopic pregnancy
Stable – methotrexate or salpingotomyUnstable – salpingectomy
450
Tx ARDS
TV at 4-6 ml/kgPermissive hypercapniaP/E < 200 --> high PEEPP/E < 300 --> prone, nm blockade,
451
Pitfalls of hiatal hernia repair
Left gastric artery along right crus Abberant left hepatic artery in the gastrohepatic ligament vagus nerve
452
MEN genes
1- MENIN2- RET
453
Dx of:Insulinoma:Gastrinoma:Glucagonoma:VIPoma:Somatostatinoma:
Dx of:Insulinoma: insulin to glucose ratio > 0.4 after fasting; ↑ C peptide and proinsulin Gastrinoma: serum gastrin > 1000 or SS testGlucagonoma: gasting glucagon levelVIPoma: high VIP and dx of exclusionSomatostatinoma: fastin somatostatin level
454
Incidentally found Meckel's
Child and young adult- resection of the normal-appearing Meckel's diverticulum healthy, young adults (<50 years of age)- resection of the normal-appearing Meckel's diverticulum if there is a palpable abnormality or longer than 2 cm >50 years of age, and patients with significant comorbidities- not resecting
455
Chemo drh
loperamide --> octreotideconsider c. diff testing if copious or resistant
456
Choledochol cyst epidemiology
females and asians15% get cholagioncarcinoma
457
Tx of desmoid tumors
Women, benign but locally invasive; ↑ recurrencesGardner’s syndromePainless massTx: wide local excision if possible; if involving significant small bowel mesentery, excision may not be indicated → often not completely resectableMedical Tx: sulindac and tamoxifen
