Fun Facts

Question 1

Vital Capacity

Answer 1

Is the amount of air that can maximally be expired after a maximal inspiration.

Inspiratory Capacity + Expiratory Reserve Volume

Question 2

Tidal Volume

Answer 2

Is the amount of air moved in a normal breath

Question 3

Reserve volume

Answer 3

Is the amount of air left after maximal exhalation

Question 4

Expiratory Reserve Volume (ERV)

Answer 4

Is the amount of air left after exhaling a normal breath.

Question 5

Functional Residual Capacity (FRC)

Answer 5

Is ERV + RV

Question 6

What is the predominant cellular source of TNF?

Answer 6

Macrophages

Question 7

Zinc Deficiency

Answer 7

• Failure to thrive
• skin rash!!!!
• impaired wound healing

Question 8

Selenium deficiency

Answer 8

Cardiomyopathy, hypothyroidism, neurological changes

Question 9

Chromium deficiency

Answer 9

Hyperglycemia, confusion, peripheral neuropathy

Question 10

Cooper deficiency

Answer 10

Pancytopenia

Myelopathy (neuropathy + ataxia)

Question 11

Vitamin B12 deficiency

Answer 11

Megaloblastic anemia

Peripheral Neuropathy

Question 12

Treatment of choice for a low, simple and some mid-rectovaginal fistulas?

Answer 12

Endorectal advancement of an anorectal flap technique

Question 13

Type I hypersensitivity reaction

Answer 13

Anaphylaxis (IgE-mediated) causing mast cell and basophil degranulation.

Remember:

1) C1 esterase deficiency
2) blood transfusion in IgA def pts.

Question 14

Type II hypersensitivity reaction

Answer 14

Cytotoxic-mediated- immunoglobulins attached to a surface Ag with subsequent complement fixation (ie. Hashimoto thyroiditis) or autoantibodies attached to cell surface receptors (ie. Grave’s Disease).

Question 15

Type III hypersensitivity reaction

Answer 15

“Serum-sickness”- circulating Ag-Ab reactions with subsequent complement fixation.

Leads to deposition of immune complexes into vessels, joints, and kidney.

Question 16

Type IV hypersensitivity reaction

Answer 16

Cell-mediated immunity

Eg: contact dermatitis like poison ivy

Question 17

Vitamin K deficiency

Answer 17

Decrease coagulation factors (II, VII, IX, X) leading to bruising and hemorrhages.

Associated with:

• TPN use
• colonic resection
• poor PO intake
• hepatic diseases

Question 18

Vitamin A deficiency

Answer 18

Associated with:

Visual disturbance (night blindness and ocular keratitis)

Question 19

Vitamin E deficiency

Answer 19

Can be seen in prolonged steatorrhea

Sx: neuronal degeneration, neuropathy, spinocerebellar ataxia

Question 20

Vitamin D deficiency

Answer 20

Associated with:

Osteomalacia,
pathologic bone fractures,
proximal myopathy

Question 21

Pulsion Esophageal Diverticulum

Answer 21

Zenker Diverticulum

Proximal (above cricopharynxgeus muscle) or distal esophagus

False diverticulum (only mucosa and submucosa)

Question 22

Traction Esophageal Diverticulum

Answer 22

True diverticulum (all 3 layers)

Occurs mid- esophagus

2/2 inflammatory process in the lymph nodes surrounding esophagus

Question 23

Standard initial treatment for infants with biliary atresia?

Answer 23

Kasai procedure (Roux-en-Y hepatic portoenterostomy)

Question 24

Treatment for Stage I, IIa and IIb neuroblastomas with “low risk” classification?

Answer 24

Surgery alone

Question 25

Anatomy of inguinal canal

Answer 25

Inguinal ligament inferiorly Conjoint tendon posteriorly External oblique aponeurosis anteriorly Combination of external oblique aponeurosis and musculoaponeurotic extensions of internal oblique and transversalis muscle superiorly

Question 26

Lichtenstein Inguinal Hernia Repair

Answer 26

Inguinal floor is reconstructed using a synthetic mesh. The inferior border of the mesh is sewn to the shelving edge of the inguinal ligament - Be careful going inferior to this shelving edge, may found external iliac vessels The medial egde is sewn to the conjoint tendon medially and the internal oblique & transversalis fascia superiorly

Question 27

The most common sites of melanoma recurrence are?

Answer 27

Skin Subcutaneous tissues Distan lymph nodes

Question 28

Phimosis

Answer 28

Inability to retract the foreskin past the glans of the penis. In an emergent setting a dilation or temporizing dorsal slit circumcision can be performed. Circumcision is the definitive treatment performed on an elective basis.

Question 29

Management of asymptomatic branch duct-IPMN less than 3cm in diameter without radiographic or cytologic findings concerning for cancer

Answer 29

Serial cross sectional imaging

Question 30

Management of branch duct-IPMN greater than 3cm, or any symptomatic, or any with radiographic (mural nodules) or cytologic findings concerning for malignancy

Answer 30

Needs resection

Question 31

Melanoma seen in sun-exposed elderly patient and associated with slow growth and best overall prognosis?

Answer 31

Lentigo malignant melanoma

Question 32

Most commons subtype of malignant melanoma?

Answer 32

Superficial spreading melanoma Initially grows in a radial fashion

Question 33

Melanoma with the worst overall prognosis is?

Answer 33

Nodular melanoma

Question 34

What is the MOST common metastatic tumor to the small bowel (via hematogenous spread)?

Answer 34

Melanoma

Question 35

What is the largest risk factor for postoperative cardiac complications?

Answer 35

Uncompensated or active CHF.

Question 36

Treatment of Stage III rectal CA (any N involvement but M0)

Answer 36

Neoadjuvant Chemoradiation -> Surgery -> adjuvant chemotherapy

Question 37

Most common ANAEROBE in the colon?

Answer 37

Bacteroides fragilis

Question 38

Most common AEROBIC bacteria in the colon?

Answer 38

E. Coli

Question 39

Treatment of Fulminant C. Diff colitis?

Answer 39

Total colectomy with end ileostomy

Question 40

0.9% NSS composition

Answer 40

Na+ 154 | Cl - 154

Question 41

Lactate’s Ringers composition

Answer 41

``` Na+ 130 Cl - 109 K+ 4 Ca 2.7 Lactate 28 (converted to HCO3-) ```

Question 42

Plasma Osmolality Formula

Answer 42

(2 x Na) + (Glucose/18) + (BUN/2.8) Normal values are: 280-295

Question 43

Diabetes Insipidis

Answer 43

Low ADH -> increase UOP, increase Na, dilute urine (decrease urine specific gravity), increase serum osmolarity Can occur with ETOH, head injury If acute Tx: DDAVP If chronic tx: free water

Question 44

SIADH

Answer 44

High ADH -> low UOP, low Na, diluted serum (low osmolarity), concentrated urine Can occur with head injury If acute tx: conivaptan, tolvaptan If chronic tx: fluid restriction & diuresis

Question 45

Treatment of hypercalcemia

Answer 45

Normal saline @200-300 cc/hr and Lasix

Question 46

Glasgow Coma Scale

Answer 46

Motor (6)- follows commands, localizes pain, withdraws from pain, decorticate, decerebrate, no response Verbal (5)- oriented, confused, inappropriate words, incomprehensible sounds, no response Eye Opening (4) - spontaneous, to command, to pain, no response

Question 47

Nerve of Grassi

Answer 47

Comes from the RIGHT posterior vagus nerve If not cut during vagotomy, can cause acid hypersecretion