High Yield 2023 Flashcards

Question

W/up and Tx testicular mass: - Seminoma - Non-seminomatous

Answer 1

1. PE 2. Ultrasound 3. AFP, HCG, LDH - Seminoma: no AFP!` - Non-seminoma: high AFP, HCG, LDH 4. Inguinal orchiectomy: any patient with solid testicular mass 5. Based on path/markers decide: - Seminoma: XRT - Non-seminomatous: retroperitoneal node dissection **ligate cord at level of internal ring so it can later be removed with retroperitoneal node dissection

Answer 2

1. Pyogenic: after cholangitis (MC) or div's; - drain and abx (+mica if fungal) 2. Amoebic: after mexico trip (or aMazon). - dx w/ serology/hemagglutination 1st - metronidazole (no drain) 3. Echinococcal: wall Ca+ and sub-cysts - albendazole and resect/PAIR 4. Fungal: 2/2 chemo/neutropenia - perc drain + micafungin

Answer 3

Genes: - MLH1 - MSH2, MSH6 - PMS2 - EPCAM Fxn: DNA MM repair gene causing microsatellite instability

Answer 4

1. Hemangioma: only if sxatic or KM syndrome - enucleate (or resect); angioembo if active bleed 2. FNH: NTD 3. Adenoma: resect if < 4cm w/out OCP response or > 4 cm, male, or growing

Answer 5

Indications for total thyroidectomy: - Tumor > 4cm - Tumor 1-4cm and patient preference - Distant mets or extra-thyroid disease - Nodal disease - Poorly differentiated - Prior radiation *micro-mets do not count as distant disease **if thyroid lobectomy only: tx with thyroid hormone to suppress TSH, get serial U/S to monitor

Answer 6

VHL gene - upreg. of VEGF 1. Brain/retinal hemangioblastoma- q2y brain MRI 2. Clear cell RCC- q1y US/MRI of abdomen 3. Pheochromocytoma- yearly metanephrines

Answer 7

1. Punch bx or excisional bx (if small, non-sensitive area) - MIS- 5mm margin - <1mm- 1cm - 1-2mm- 1-2cm - >2mm- 2cm 2. Clinical positive nodes (stage 3) require FNA for confirmation - negative: SLNBx - positive: completion LN dissection 3. SLNBx: > 1mm (T2) or if .75-1 mm w/ ulceration or mitotic rate > 1 (T1b) 4. If SLNBx+ (stage 3): q4m US surveillance OR completion LN dissection - LN dissection: superficial 1st. Deep if cloquets+, clinically+ positive, >3+ on SLNBx, or CT+ for deep nodes **MOHS can be used for in-situ disease. Need 5 mm margin.

Answer 8

PSC: Male; intra/extra hepatic; onion fibrosis; chain of lakes - a/w Ulcerative colitis, cholangioca PBC: Female; intra hepatic; granulomas; +AMA - a/w Sjogren, RA tx: trx, cholesty., UDCA - meds generally don't help

Answer 9

1- pancreatic (gastrin), pituitary (prolactin), parathyroid (PTH); menin; AD 2a- Parathyroid (PTC), MTC, Pheo (catecholamines); ret; AD 2b- Pheo, MTC, marfanoid/neuroma; ret; AD

Answer 10

Px: nitrites, Hurricane spray, fertilizers, g6PD def, seretonergic drugs - Fe2+ to Fe3+ impairing O2 binding Dx: blood gas measurement and pulse ox says 85% - MethHb level > 20% Tx: methylene blue or vitamin C (for g6pd or ser)

Answer 11

1. unprovoked: malignancy, inherited ➡ indefinite 2. provoked: surgery, travel, preg, OCP, immbility ➡ 3m Special cases: - ileofemoral: cather directed thrombolysis - open thrombectomy ➡ extensive (ileofemoral) DVT OR phlegmasia - Superficial femoral vein is a DVT - Pregnant ➡ use Lovenox. NOAC and Coumadin are c/i

Answer 12

Dx: palpable neck mass + Ca > 14 is presumptive dx. Otherwise, dx intra-op based on gross features. - FNA is not recommended - Treat based on intra-operative gross invasion. Frozen section is not helpful. Tx: 1. Control hypercalcemia: usually > 14 - IV fluids 1st! Then bisphosphonates - cinacalcet (sensipar - ca mimetic) 2. Parathyroidectomy w/ hemithyroidectomy (+/- L6/central neck dissection +/- XRT) - no chemo - usually don't perform any node dissection unless palpable nodes

Answer 13

1. Graves: IgG stimulates TSHr ➡ hyperT - BB, PTU, RAI ➡ thyroidectomy 2. TMN: chronic TSH stimulation ➡ hyperT - BB, PTU, RAI ➡ total/subtotal thyroidectomy 3. Hashimoto's: antiTPO/TG Ab ➡ hypoT - thyroxine ➡ partial thyroidectomy 4. DeQuervains/Subacute: viral URI - NSAIDS/ASA ➡ steroids 5. Reidels: autoimmune inflammation - steroid, thyroxine ➡ extensive fibrosis often need surgery for compression

Answer 14

- chromosome 5 - 1st mutn in adenoma to carcinoma - mc mutation in colon ca - a/w FAP

Answer 15

1. Carcinoid- Kulchinsky cells (enterochromaffin-like) tx- < 2cm ➡ appendectomy; > 2cm ➡ R hemi/oncologic resection; chemo if unresectable 2. GIST- cajal cells tx- resection, imantinib 3. Desmoid- spindle cells tx- resect if extra-abdominal. NSAID/estrogen if intra

Answer 16

- Tissue typing - Donor organ: carries Ag (on WBC) - Recipient body: carried Ab Recipient serum with donor wbc

Answer 17

1. urine metanephrine to r/o pheo 1st 2. tx pheo 1st w/ adrenalectomy 3. Address thyroid - 2A: total thyroid + bilateral central neck by 5y - 2B: total thyroid + bilateral central neck by 1y

Answer 18

1. HyperPTH 1st w/ 4-gland resection (hyperplasia not adenoma) + thymectomy (remove ectopics) 2. Asses other lesions

Answer 19

Glucagon: alpha cells of pancreas - glycogenolysis, gluconeogenesis Insulin – beta cells of the pancreas - cellular glucose uptake; promotes protein synthesis

Answer 20

1. T0 or T1 (submucosa) 2. < 3 cm 3. < 30% circumference 4. Palpable on DRE (<8cm from anal verge) 5. No high-risk features (poorly diff, LV invasion) **local recurrence rate is higher

Answer 21

1. CRC: scope q1-2y starting at 20-25 - Surgery if: CRC or endoscopically unresectable lesions - TAC with IRA w/ q1y rectum surveillance 2. Endometrial ca - childbearing: endometrial sampling q1y - after children: TAH-BSO 3. Ovarian ca: annual pelvic exam and TVUS

Answer 22

Duo atresia: newborn; bilious emesis directly after birth - a/w down syndrome -dx: AXR- doube bubble -tx: duodenoduodenostomy TEF: newborn, spit ups. can't place NG. resp sxs - dx: AXR- gasless (A), gas (C) - tx: right extra-pleural thoracotomy Pyloric stenosis: 1-3 months; NB projectile vomiting -dx: U/S- 4mm thick, 14 mm long -tx: pyloromyotomy Intussusception: 3m-3y; currant jelly stool - dx: U/S w/ bull's eye - tx: air contrast enema Malro: 1y-5y; sudden onset bilious emesis - dx; UGI- no duo sweep (any child w/ bilious emesis) - tx: ladd's procedure

Answer 23

Stomach and Right gastroepiploic - if you notice this is out then stop the procedure and discuss conduit options at a later time (don't go for colon or jejunum b/c needs to be prepped)

Answer 24

1. Cryo, curettage, 5-FU, laser - Excise if > 3cm, sxatic, atypical w/ 4-6 mm margin 2. Lifetime surveillance even if tx! - Bowen disease = SqCC in situ = high grade AIN - Actinic keratosis is precursor *vs. pagers disease- excision

Answer 25

1. hyper-acute: w/in 1 hour - path: ABO Ab (t2 HS) - px: mottled organ - tx: remove organ 2. acute cellular: days-weeks; change in organ function - path: B or T (t4 HS) - px kidney: lymphocytic infiltration, tubulitis - px liver: endothelitis, portal triad lymphocytosis - tx: increase IS or pulse steroids ➡ IVIG 3. chronic: months-years - path: B or T (t4 HS) - px kidney: interstitial fibrosis, tubular atrophy - px liver: bile duct atrophy - px heart: vasculopathy and atherosclerosis; 1/2 @ 10y - px lung: bronchiolitis obliterans; 1/2 @ 5y - tx: increase IS or re-trx (no good options)

Answer 26

1. Gastrin - G cells in antrum - ↑ HCl, IF, and pepsinogen 2. Somatostatin – D cells in pancreas - inhibits gastrin, HCl, insulin, glucagon, secretin, CCK, motilin, pancreatic/biliary/stomach output 3. CCK – I cells of duodenum - gallbladder contraction, relaxation of sphincter of Oddi, ↑ pancreatic enzyme secretion (acinar cells) 4. Secretin – S cells of duodenum - ↑ pancreatic/GB bi release (ductal cells), inhibits gastrin release (this is reversed in patients with gastrinoma), and inhibits HCl release 5. VIP – pancreas and gut - ↑ intestinal secretion (water and electrolytes) and motility

Answer 27

1. imbibition (direct diffusion) 2. inosculation (cap beds meet) 3. revascularization

Answer 28

2, 3, 4, 7, 10, 11, 12 - innominate seperates level 3, 4 - 4: carinal - 7: sub-carinal - 10: R/L hilar -n2 nodes: 1-9 -n1 nodes: 10-14 - cannot sample 5, 6 (sub-aortic/AP window) ➡ chamberlain procedure (Parasternal mediastinotomy) - 8 (para-eso), 9 (IPL) ➡ EUS or VATS

Answer 29

1. Hemostasis: PMNs (24-48h) - PMNs: remove necrotic tissue, release ROS's 2. Inflammatory: monocytes/macrophages (48-96h) - mphage: growth factors, angiogenesis, cell proliferation - chronic wounds arrest in this stage 3. Proliferative: fibroblasts (3d+) - fblasts: collagen production and secretion 4. Maturation: fibroblasts (10d) - myofibroblasts for wound contraction

Answer 30

Tx: 1. Resectable if: - contralateral hemi-liver with intact HA, PV, and biliary drainage with no tumor - no distant mets or organ invasion 2. Consider location - Upper ⅓ (Klatskin): lobectomy and stenting of contra lobe - Middle ⅓: hepaticojejunostomy - Lower ⅓: pancreaticoduodenectomy (Whipple) 3. Consider chemo + transplant if unresectable

Answer 31

dx: MRI then EUS/FNA; high CEA, high amylase tx: 1. Branched - resect if >3 cm, sxs, or signs of malig (nodule) - Otherwise surveillance 2. Main duct - resect if > 1 cm or sxs (60% chance of Ca) - 5-9 mm EUS/FNA. Resect if SOMalig - < 5mm, surveillance MRIs

Answer 32

Right ➡ Posterior trunk- criminal nerve (post), celiac branch (ant), post laterjet Left ➡ Anterior trunk- hepatic branch, ant laterjet 1. Truncal vagotomy: transect ant/post @ distal eso - removes lesser curve and pylorus nerve - need pyloroplasty. high r/o dumping syndrome 2. Highly selective: transect @ crow’s ft, preserve laterjet - removes innervation to lesser curvature - preserves pylorus → no drainage procedure - lowest morbidity

Answer 33

Emergent: 1. Steroids +/- abxs 2. Infliximab, Cyclosporine 3. No response, megacolon (> 6 cm), HDUS, or perf ➡ TAC with end-ileostomy - When stabilized can perform proctectomy and IPAA - Don't do proctectomy in emergent situations Elective: - Indications: dysplasia, cancer, refractory disease - PC w/ IPAA ** Surgery reduces: erythema nodosum, arthritis -- no effect on PSC or ank spondy

Answer 34

Px- intestinal hamartomas (intususpeption), pigmented oral mucosa, polyposis - Cancers: GI tract, breast, pancreatic - AD, STK11 mutation Screening - Scope @ 25y then q2 years b/c high r/o GI/pancreas ca

Answer 35

1. neurogenic PT: PT --> rib resection, scalenectomy, BPlex dissection 2. venous- catheter-directed thrombolysis → surgical decompression 3. arterial- C7/1r resection, subc artery resection/reconstruction

Answer 36

Dx: > 100 adenoma or < 100 w/ fam hx - AD; APC mutation - CA by 40 - desmoid tumors (slow growing abdominal wall mass) Tx: - sigmoidoscopy q1y at 10 (don't need colonoscopy) - EGD @ 20 or when polyps start- SB polyposis - TAC w/ IRA or PC w/ IPAA depending on rectal involvement at about 20 (or once florid polyposis is seen) - q1y EGD post op for duodenal cancer (MC COD) - q1y c'scope if TAC - polyposis/high grade dysplasia @ stump → proctectomy +/- pouch - desmoid: resect. Anti-E if intra-abdominal

Answer 37

female breast, ovarian, male breast I (ch17)- 60, 40, 1 II (ch13)- 60, 10, 10 Tx: -pre-meno: offer bilateral mastectomy OR q1 MRI starting @ 25 -post meno: bilateral mastectomy + SOO + HRT until 50 (no TAH) **SOO decrease r/o OVARIAN Ca (80%) for BRCA1/2 AND breast Ca for BRCA2 only (50%) **No TAH!

Answer 38

1. all functioning tumors 2. all > 6 cm ➡ open resection 3. if < 6cm with suspicious features - >10HU, <50% @ 10m w/out ➡ open resection **DO NOT biopsy first

Answer 39

1. Adjuvent chemo: tumor > 1cm, nodal dz, triple neg - echo before for cardiotox 2. Tamoxifen/Anastrazole: 5y for HR+ tumors - Tamox for men 3. Trastuzumab- 1y for Her2/neu+ tumors - echo before for cardiotox

Answer 40

Both released by duo S cells ➡ Secretin- duct cells ➡ bicarb I cells ➡ CCK- acinar cells ➡ enzymes

Answer 41

1. Indications for total thyroidectomy: - Tumor > 4cm - Distant mets or extra-thyroid disease - Poorly differentiated - Prior radiation 2. Nodes dissection: A. Lateral neck dissection: of involved compartments if palpable or bx+ nodes B. Prophylactic neck dissection (level 6): if > 4cm, extra-thyroid invasion, +lateral nodes. - Usually not performed for follicular 3. Radio iodine indications (6w post op, want TSH high) - Only after total thyroidectomy to be effective - For high risk tumors: tumor > 1 cm, extra-thyroidal disease

Answer 42

Mammogram every 2–3 years after age 40 then yearly after 50 High-risk screening - mammogram 10 years before the youngest age of diagnosis of breast CA in first-degree relative

Answer 43

- BB overdose: fluids/atropine → glucagon - CCB: Ca + Insulin + Atropine + Pressor - Tylenol: NAC - Benzos: flumazenil - CN/Nitroprusside: sodium thiosulfate, amyl nitrite - Vecuronium/Rocuronium: sugammadex - Ethylene glycol: femopizole and bicarb OR ethanol; iHD - Methemoglobinemia: methylene blue

Answer 44

1. Crypto- CNS sxs in AIDs pt tx- amphotericin 2. Coccidio- pulm sxs in the southwest tx- amphotericin 3. Histo- pulm sxs in ohio river valley tx- itraconazole → ampho B (only if sxs) 4. Mucormycosis- burns/trauma w/ bloody cough tx- emergent debride, ampho

Answer 45

eso- 15/7cm stomach- 15/5cm colon-12/5 cm rectum- 12/5 cm

Answer 46

Cohort: prosepective; exposed vs. non-exposed RR- [a/a+b]/[c/c+d] Case control: retrospective; diseased vs. non-diseased OR- (a/b)/(c/d) - good initial study to show an association

Answer 47

- gene: p53 mutation; TSG on Ch17; AD inheritance - mech: cell cycle regulation at G1/S to promote apoptosis in DNA damaged cells - px: breast ca + sarcoma b4 45

Answer 48

Px: Common 2/2 B cell lymphoma - hyperU, K, Ph w/ hypoCa Path: CaPh crystal ➡ renal failure + hypoCa tx: IV hydration ➡ iHD

Answer 49

NNT = 1/absolute risk reduction (ARR) - ARR = event rate in intervention group - rate in control group - RR = event rate in intervention / rate in null group - RRR = (rate control - rate experimental) / rate control

Answer 50

- Pyloric stenosis: pyloromyotomy - Intussusception: air contrast enema - Duo atresia: DD or DJ - TEF: right extrapleural thoracotomy - Malro: LADDS proc

Answer 51

1. Dx: MC GI Sarcoma - EGD + FNA: SM smooth EGD mass with normal overlying mucosa and central ulcer. Stomach MC. - Bx: cajal cells. c-KIT+ - don't require bx if high suspicion 2. Tx: wedge resection (gross margin) - can be R0 or R1 resection - Imatinib (TK inhibitor) ➡ 5cm or >5 mitosis/50 hpf - mitosis/hpf is most predictive of prognosis (>mets) - neoadjuvant if need to down-stage for resection - adjuvant for 3 years

Answer 52

type 1: false positive - say something is true (reject the null) when it's not - alpha = prob of type 1 error. Set at .05 - minimize by decreasing stat significance type 2: false negative - say something is false (do not reject the null, accept H0) when it's true - beta = prob of type 2 error. Set at .2 - minimize by increasing sample size/power **power = 1 - type 2 **reject the null = "a difference exists"

Answer 53

Bx: Goblet cells and columnar cells - No dysplasia: 4 quad every 2 cm q 3-5y - LGD: 4 quad every 1 cm q 6m - HGD: ablation/endoscopic resection. q3m *Fundoplication is only c/i in HGD *No screening if asx

Answer 54

HNPCC: fulfill amsterdam criteria - 3+ relatives with Lynch syndrome-associated cancers (CRC, endometrium, small bowel, ureter, renal) - 2 generations - 1 ca dx < 50 yo Lynch syndrome: refers to mutation in DNA MM repair gene (MLH1, MSH2, MSH6, PMS2) or the EPCAM gene. - should test in all with new onset CRC

Answer 55

6- obeys commands 5- localized 4- w/draws 3- flexion (decort) - 'flex your core' 2- extension (decErebrate) 1- none

Answer 56

- HAP/VAP: staph aureus (pseudomonas #2) - central line infection: coag negative staph (staph epi) - SSI: staph aureus - UTI: e. coli - GI infection: c. diff - SBP: e. coli - Cholangitis: e. coli - NSTI: polymicrobial - ICU infection: VAP - Fungal infection: hitsto (asperg if I/C) - graft infection: staph aureus (early), staph epi (late)

Answer 57

- Nigro protocol- RTx (of Ca + inguinal/pelvic nodes) + 5FU + MitoC - Recurrence (10-20%): must wait at least 6 month to diagnose ➡ salvage APR - Lateral to I/S groove (anal margin): tx like skin cancer SqCC equivalents- large cell ker. (SqCC), transitional zone, LCl non-ker, basaloid, mucoepidermoid

Answer 58

t1a: muscularis mucosa: endo resection t1b: SM: upfront esophagectomy (or low grade t2) t2: muscularis propria: neoadjuvant - low risk: upfront esophagectomy t3: adventitia: neoadjuvant *no serosa. Ca spread through SM lymphatics

Answer 59

Tacro: calcineurin inhibitor; bind fK ➡ calcineurin ➡ block IL2 - 100x more potent than cyclosporine - neuro sxs (tremor), GI sxs - nephrotox, hepatotoxic - DM - alopecia Cyclosporine: calcineurin inhibitor; bind cyclophillin ➡ calcineurin ➡ block IL2 - nephrotox, hepatotox, neuro sxs - gingival hyperplasia, hypertrichosis - cycled in bile, gallstones Sirolimus: bind fK ➡ mTor inhibitor (IL2 inhibitor) - impaired wound healing - interstitial lung disease - lymphocele

Answer 60

-2-6m: piecemeal removal -1 year: > 10 adenomas -3 years: 3+ adenomas, HGD, > 1cm, villous elements -5 years: 1-2 tubular adenomas (< 1cm) -10 years: hyperplastic polyps (<20)

Answer 61

Start with lobectomy Indications for total thyroidectomy: - Tumor > 4 cm (1-4 cm, close observation or total) - Extra-thyroidal disease - Multi-centric or bilateral lesions - Previous XRT Consider ppx level 6 for high risk If thyroid lobectomy only: - Tx with thyroid hormone to suppress TSH - Get serial U/S to monitor Indications for MRND - extra thyroid extension Radio iodine indications (6w post op, want TSH high) - Consider for 1-4 cm, definitely > 4cm - Extra-thyroidal disease - Need total thyroidectomy to be effective

Answer 62

5- normal 4- confused 3- inappropriate words 2- incomprehensible 1- none

Answer 63

1. HGD, TIS, T1a: endoscopic ablation/resection 2. T1b: upfront esophagectomy or endo ablation (if low risk) 3. T2 or N: neoadjuvant then esophagectomy - Low grade T2 (< 3cm, no L/V invasion, well diff): upfront eso 4. T4b or M: definitive chemo-XRT < 5cm from cricoP: definitive chemo-XRT > 5 cm from cricoP: esophagectomy

Answer 64

tx: < 2cm observe > 2cm: - skinny neck: thrombin injection - wide neck: operative intervention Surgery for complicated disease: - infxn (cellulitis) - skin necrosis, skin changes - neuro deficit, AMS - HDUS, pulsatile,

Answer 65

- Recurrent laryngeal: MC cranial nerve; 2/2 clamping; hoarseness - Marginal mandibular: excessive retraction and angle of jaw; Ipsilateral lip palsy - Hypoglossal nerve: ipsilateral tongue deviation - G/Ph nerve: from high dissection; difficult swallowing - Superior laryngeal: high-pitch - Accessory: failure to shrug shoulders

Answer 66

1. Afferent limb obstruction: prevent with afferent limb < 20 cm - acute: convert Bil 1 or REY (STAT!) - chronic: Bacterial overgrowth: try abxs 1st (Rifaximin) . convert to REY 2. Dumping syndrome: small meals, no sugar --> octreotide 3. Alkaline reflux gastritis: prevent w/ roux limb > 40 cm. - pro-kinetics, bile-acid binding ➡ convert to REY with long roux

Answer 67

1. 1st 4 hours: exogenous glucose 2. 4h-1d: Liver glycogen 3. 1d-1w: gluconeogenesis phase (alanine from muscle) 4. 1w+: protein-sparing phase - FA/Ketones are used everywhere - RBCs use glucose only

Answer 68

1. Linoleic acid- omega-6 (Cis, Unsturated) - inflammatory 2. α-linolenic acid- omega-3 (Cis, Unsturated) - anti-inflammatory Immuno-nutrition = arginine, omega-3 FA - a/w less infections, shorter LOS

Answer 69

BSC: most common malignancy in USA; pearly, rolled borders, peripheral palisading; MC upper lip ca SqCC : scaly patch; keratin pearls, parakeratosis, full-thickness pleomorphism (partial = AK); MC lower lip ca - MC ca after trx Tx: - 4 mm for unaggressive: well differentiated and < 2 cm - 8 mm for aggressive: poorly differentiated or > 2cm - 1 mm for MOHS - MOHS for aggressive subtypes - LADN'y for clinical positive nodes - Can consider SLNBx for high risk SqCC - Limited role for chemo/XRT

Answer 70

Dx: "onion skin" in diaphysis - pelvis is MC location Tx: chemotherapy (1st line) + surgery or XRT

Answer 71

w/up: 1. doppler U/S: check vasc/urteter mosis, bladder outlet obstruction 2. empiric fluid bolus Causes 1. Immediate: arterial thrombosis- nephrectomy 2. Weeks: lymphocele- open/lap peritoneal window 3. Months: polymovirus (BK)- nephrostomy + reconstruction

Answer 72

1. TG duct: midline through hytoid bone; sistrunk procedure - if infected tx w/ abxs first 2. Brachial cleft: anterior SCM; resection - 2nd cleft cyst MC (mid/lower neck) 3. Cystic hygroma: posterior triangle; resection (avoid infection)

Answer 73

Cause- AI attack of adrenal cx Labs- hypoNa, hyperK Dx: cosyntropin stim test - cortisol remains low - deceased cortisol and aldo with high ACTH Tx- steroids

Answer 74

px: moon facies, striae 1. Initial tests: choose 1-2 - 24h urine free cortisol (most se) - late night salivary cortisol (when cortisol is lowest) - overnight 1 mg dexa suppression 2. ACT Level A. ACTH normal/high - high dose dexa suppresion - no suppression: small cell lung ca - suppressed: pituitary adenoma (Cushing's disease) (MC endogenous) B. ACTH low - CT positive: adrenal mass - CT negative: exogenous (most common)

Answer 75

Dx: neuroendocrine tumor - 24H urine HIAA or serum chromo A - chromoA can give false + if on PPI - Octreotide scan if can't locate Path: +chormogranin. desmoplastic mesentery. - grade ~ Ki67 index Px: - Rectum > SI (ileum) > Appendix (MC tumor of appendix) - GI tract > pulm > GU. Rectum MC GI source - Carcinoid Synrome: 2/2 liver mets. Flushing, DRH, bronchospasm. R-sided heart failure. Tx: - SS analogues (lanreotide) give sx relief - < 2 cm: local excision (transanal, appendectomy, segmental) ➡ no further w/up. no staging/ppx regimen - > 2 cm: staging CT. formal cancer resection. - all lung carcinoids get formal resection with MLND

Answer 76

PPV = of those who test + how many have the dz NPV = of those who test - how many do not have the dz Increasing prevalence = increase PPV and decrease NPV

Answer 77

Correlation coeff between -1 and 1 1 = very strong positive (direct proportion) > .7 = strong positive 0 = no correlation - .7 = strong negative Do not determine causation

Answer 78

1. Safety in a small group of humans 2. Effectiveness and side effects 3. RCT compared to standard of care 4. Long term safety and monitoring

Answer 79

A/w FAP (after surgery, 2nd MCCO death), Gardner syndrome Path- non calcified, fibrotic, low mit index, spindle cells Tx: - WLE for extra-abd; NSAID, anti-Estrogen (tamoxifen) if intra! - XRT if sensitive area

Answer 80

1. Dexa suppression (cortisol) 2. Urine androgens (sex hormones) 3. Plasma metanephrines (pheo) 4. aldo/rennin ratio > 30 (salts)

Answer 81

1. Idiopathic bilateral adrenal hyperplasia (60%)- medical 2. Adrenal adenoma (Conn's syndrome)- lap adrenal 3. Adrenal adenoca- open adrenal + mitotane * Can use adrenal vein sampling to distinguish

Answer 82

Triple phase CT: 1. Unresectable- distant met, >180 SMA/celiac, any aorta/IVC, unreconstructable PV/SMV - EUS/FNA for tissue dx for neoadjuvant 2. Borderline- <180 SMA/celiac, reconstructable PV/SMV - EUS/FNA for tissue dx for neoadjuvant 3. Resectable - dx lap (to confirm resectability) + whipple

Answer 83

Px: intractable pruritis, eczematoid rash Tx: scope (r/o malignancy) - dc topical agents - perianal punch bx + WLE

Answer 84

Criteria - bilateral HA or PV - unilateral HA with extensive contra duct Tx - no extrahepatic dz ➡ neoadj chemo-XRT + liver trx - extrahepatic dz ➡ chemo-XRT

Answer 85

1. Cholangioca and HCC: US/MRI/MRCP q6-12m. Annual CA 19-9 2. GB CA: US q6-12m 3. CRC: colonscopy q1-2 years (regardless of UC)

Answer 86

1. Exam and CEA q3-6m x 3 years 2. Colonoscopy @ q1, 3, and 5 years - No prior scopes: q3-6m (intra-op scope is difficult in un-prepped bowel) 4. CT CAP q1y x 3 years

Answer 87

1. TRUS (avoid if > t2) or MRI- T/N stage - suspicious nodes on MRI count as clinical stage N (neo-adj) 2. CT CAP- M stage 3. C'Scope- for initial dx and sync lesion. not for T stage 4. Rigid Sig'Scope- for distance from anal verge (required! even. if c'scope done)

Answer 88

1. Segmental colitis- partial colectomy 2. Rectal sparing pan-colitis- TAC w/ IRA 3. Pan-colitis w/ rectum- PC w/ end ileostomy - IPAA whether w/ or w/out loop should NOT be done on Crohn's b/c r/o pouchitis

Answer 89

1. CRC: q1y C-scope @ 20-25; TAC w/ IRA or TPC w/ IPAA if CA or unresectable adenoma. q1y scope post op (metachronous CA) 2. Endometrial: q1y endometrial sampling @ 30-35; ppx TAH-BSO after children 3. Ovarian: q1y TVUS and Ca-125 @ 30-35; ppx TAH-BSO after children 4. Stomach: EGD/Bx q2-3y @ 30-35 5. Renal: q1y UA and US @ 30-35

Answer 90

-Muir-Torre: MLH/MSH; sebaceous gland tumor -Gardner: APC; desmoid tumors, osteomas, epidermal cysts/lipomas -Turcot: APC; Malignant CNS tumors -P/J: STK; myocutameous pigmentation -Cowden: PTEN; Hamartoma polyps, endometrial/breast/thyroid CA -JuP: SMAD4; epistaxis, AVM, telangiectasia

Answer 91

1. Glucagonoma: glucagon > 1k; NME, DM, DVT (no stones vs. SS'oma) 2. Inuslinoma: fasting I/G > .4 and high C-pep; whipple triad 3. Gastrinoma: G > 1k or increase G w/ sec; refractory PUD, HyperCa 2/2 MEN1 4. VIPoma: high fasting VIP (exclude other causes); DRH, Achlorhydria, hypoK (2/2 DRH) 5. SSoma: High fasting SS; DM, stones, steatorrhea *Do not perform imaging or go to the OR until biochemical diagnosis!

Answer 92

-W/up: MRI/MRCP or PP CT ➡ >1.5 cm, sxs, dilated main duct, solid component, fam hx ➡ EUS/FNA 1. Serous cystadenoma: low M/CEA, low Am; resect if sxs 2. MCN: high M/CEA, low Am; resect 3. IPMN: high M/CEA, high Am; resect if main duct or > 3 cm 4. Pseudocyst: low M/CEA, high Am; observe x 6w; if sxs or > 6cm cystgastrostomy

Answer 93

1. Glucagonoma: distal panc w/ splenectomy + cc'y 2. Inuslinoma: enucleate 3. Gastrinoma: enucleate if < 2 cm; >2 cm, whipple 4. VIPoma: distal panc w/ splenectomy + cc'y 5. SSoma: resect w/ cc'y

Answer 94

Lead-time bias is due to early detection. Remember the "d" in lead is for early detection. Length-time bias is due to slow cases being detected more often simply because they are slowly progressing. Remember the "g" in length is for slowly progressing.

Answer 95

1. No N2 disease (stage 1-2) ➡ up-front surgery - lobectomy + MLNDx. Can consider segmentectomy. - can wedge if 2:1 margin ratio 2. N2 disease or T4 ➡ chemo-XRT first n1- ipsi bronchial/hilar nodes n2- ipsi mediatinal/subcarinal (2-9) t1- <3cm t2- >3cm t3- >5cm OR invading pleura, chest wall, phrenic n, pericardium OR nodule in same lobe t4- >7cm OR invading DPGM, mediastinum, heart, great vessels, trachea, RLN, esophagus, vert body, carina. OR different ipsi lobe

Answer 96

1. FAP- chromosomal; APC - > 100 polyps, including small bowel (duodenum) - Surveillance: start at 10 2. HNPCC (Lynch)- microsatalite; MSH, MLH, PMS, EPCAM - <10 polyps in the colon - Surveillance: start at 20

Answer 97

1. Papillary/Follicular: lobectomy +/- total + consider ppx L6 for high risk 2. MTC: total + bilateral L6 (usually) + T3 post op - RAI is c/i 3. Hurthle: lobectomy then total + bilateral L6 4. Anaplastic: chemo-XRT +/- total if operable + central and lateral nodes 5. PT: hemi-thyroid +/- L6 (usually not) **MRND if L6 is positive

Answer 98

1. Mucoepidermoid: MC malignant - total parotid + ppx MRND + XRT 2. Adenoid cystic: malignant - total parotid + ppx MRND + XRT 3. Pleomorphic adenoma: MC benign - superficial parotidectomy 4. Warthin/Papillary cystadenoma - superficial parotidectomy

Answer 99

1. Bactrim- PCP, toxo gondi, listeria, nocardia 2. Diflucan- antifungal 3. Valganciclovir- CMV

Answer 100

1. ABO Incompatibility - A, B, O Ab 2. Cross-match: recipient serum X donor lymphocytes - preformed HLA Ab (A, B, DR). DR is most important. **Livers don't need a cross-match **Can give A2 donors to O recipients **Donor: Ags are important (WBC) **Recipient: Abs are important

Answer 101

MAC = minimum alveolar [] to prevent movement in 50% of people Low MAC = lipid soluble High MAC = water soluble - NO has highest MAC Factors that decrease MAC: older age, met acidosis, hypothermia, anemia, pregnancy - require less anesthesia

Answer 102

1. Pulm sequestration: infection w/ abnormal CXR - tx: resection 2. Cystic adenoid malformation: similar to sequestrion but communications w/ TB tree - tx: lobectomy 3. Congenital lobar emphysema: XR looks like tension PTX - tx: lobectomy 4. CDH: Bochdalek- back/left, MC; Morgagni- rare, anterior - a/w pulm HTN, NTD, malrotation - tx: intubate +/- ECMO. Delayed repair.

Answer 103

Compare PAIRED ordinal variables between two groups when normal distribution cannot be assumed - ex: patient satisfaction before and after an intervention (1-5)

Answer 104

Like a regression model but for survival analysis Allow you to control for different factors

Answer 105

- Pd1 inhibitors: pembrozilumab, nivolumab - CTLA inhibitors: ipilmumab - If Braf+: braf inhibitor remains 2nd line

Answer 106

MC soft tissue tumor in children tx: surgery + SLNBx - consider neo-adjuvent if unresectable - post-op chemo-XRT (very radiosensitive)

Answer 107

Low grade: condyloma, AIN1 High grade: AIN2, AIN3 --> should treat All patients: give HPV vaccine - High risk pt: homosexual, HIV, women w/ +pap --> screen with anal cytology or anal pap smears

Answer 108

<1 cm - endoscopic removal 1-2 cm- full thickness excision > 2cm- LAR or APR **Invasion into muscularis/LN involvement- require TME

Answer 109

1. Poor differentiation 2. Vascular/Lymphatic invasion 3. Invasion below the SM 4. < 2mm of surgical margin 5. Base involvement (Haggit 4)

Answer 110

1. CRC- q1-2y c'scope starting at 10 2. Duo/Stomach ca- EGD at 20 or when polyps occur 3. Pap thyroid ca- thyroid U/S q2-5y at 18 4. Desmoid fibromatosis- CTAP if famhx, palpable mass, or sxs

Answer 111

- CCK: I cell, SI - Gastrin: G cells, antrum and duo - Glucagon: alpha cells, pancreas - Histamine: ECL cells, stomach - Insulin: beta cells, pancreas - Motilin: Mo cells, SI - Secretin: S cells, SI - SS: delta cells, pancreas

Answer 112

Thrombus is in GSV, SSV 1. AND w/in 3 cm of Saph-fem jxn or saph-pop jxn ➡ therapeutic AC for 3-6 months 2. No near the jxns ➡ prophylactic AC for 45 days 3. Otherwise: surveillance **Superficial femoral vein is a DEEP vein **EHIT: heat induced thrombus after RFA - tx with AC until resolution if it involves femoral jxn and > 50% occlusion - < 50%: compress, NSAID, surveillance

Answer 113

- Dosal: superfial peroneal n. - 1st webspace: deep peroneal n. (is deeper) - Medial: saphenous n. - Lateral: sural n.

Answer 114

1- RCT or SR of RCT 2- Cohort study or SR of cohort studies 3- Case-control or SR of case-control 4- Case series 5- Expert opinion

Answer 115

- MutY: 10 R sided adenomas ➡ MUTYH - FAP: 100s of adenomas + desmoid ➡ APC - Peutz-Jeghers: hamartomas + skin lesions ➡ STK11 - Juvenile polyposis: hamartomoas + telangiectasias ➡ SMAD4 - Lynch/HNPCC: L sided adenomas ➡ MLH1, MSH2, MSH6, PMS2 - Cowden: hamartomas + breast/thyroid ➡ PTEN

Answer 116

- Screening scopes 8 years after onset. Scope q1-3 years thereafter. - Invisible HGD: confirm w/ high-def endoscopy q3-6m ➡ total proctocolectomy w/ IPAA - Visible HGD: 1. Resectable: endoscopic resection + serial scopes 2. Not-resectable: TC w/ IPAA - for Crohn’s can do segmental resection

Answer 117

- cant be intrahepatic (prognosis is too poor) - must be unresectable, perihilar, < 3cm - no distant mets

Answer 118

Stage: 0- superficial to MM 1- invasion into head 2- invasion into neck 3- invasion into stalk 4- in SM. superficial to MP. Mx: - all sessile are 4 by definition - 4 is an indication for resection - < 4 cancer without high risk features ➡ polypectomy alone w/ follow-up scope in 3 months - otherwise, cancer resection

Answer 119

- average risk: start at 45. Screen q 10 years. -1d relative: start at 40 OR 10y b4. Screen q5 years even if normal.

Answer 120

1. > 4 nodes on superficial dissection 2. Positive cloquet's node 3. Enlarged ileo-obturator nodes on CT 4. Clinically palpable femoral nodes

Answer 121

- PD-1: pembrolizumab; melanoma (1st line); NSC lung ca, - EGFR: cetuximab; KRAS NEGATIVE colon ca - CTLA4: ipilimumab; melanoma (2nd option) - RET: selpercatinib; MTC (MEN) - Aromatase: anastrazole; ER+ breast ca - HER2: trastuzumab; HER2+ breast ca

Answer 122

MMF: purine (T cell) inhibitor - GI sxs, myelosuppression, anemia Basilixamab: il2 inhibitor - GI sxs Azathioprine: purine (T cell) inhibitor - myelosuppression, marrow suppression, pulm fibrosis

Answer 123

Chrom: deletion of short arm of chrome 11 Px: Wilm's tumor Aniridia- absent iris GU anomalies- cryptorchidism, hypospadia, streak ovary Retardation

Answer 124

- diffuse uptake ➡ Grave's: BB, PTU, RAI ➡ total/subtotal thyroidectomy if refractory (consider lugol's solution before surgery) - focal uptake ➡ toxic adenoma: BB, PTU and lobectomy - multiple areas of increased uptake ➡ TMN ➡ RAI and/or PTU ➡ total/subtotal thyroidectomy if refractory

Answer 125

- thyroid lobectomy: thyroid hormone to suppress TSH, get serial U/S to monitor - total thyroid: monitor thyroglobulin level. thyroid hormone to suppress TSH, get serial U/S to monitor

Answer 126

MOA of abxs: - cell wall: PCN, cephalsporin, vanc - protein 30s: AG (gent), tetracyclines (doxy) - protein 50s: macrolide (azithro), clinda, linezolid - dna synthesis: quinolones (gyrase), bactrim (folate), flagyl (free radicals)

High Yield 2023 Flashcards

(150 cards)