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Flashcards in MIX 4 QBANK Deck (226):
1

definition volvulus

twisted 180°

2

x-ray findings of a cecal volvulus

kidney shape
Bird's beak

3

what vascular supply does cecal volvulus rotator around

ileocolic

4

treatment of cecal volvulus

right hemicolectomy with primary ileocolic anastomosis

5

treatment of advanced ovarian cancer metastatic

resect so no tumor greater than 2 cm left
Debulk:
multiple bowel resections
Radical hysterectomy-entire pelvic tumor mass
Bladder
Sidewall
Cul-de-sac
Titanium
Rectosigmoid

Approaches extraperitoneal ventral to dorsal technique

Splenectomy
Total omentectomy
Hepatic resection
Diaphragm peritoneal stripping

6

symptoms of lidocaine toxicity

earlier signs-
tingling of the tongue and lips
metallic taste
Lightheaded
tinitus
Visual disturbances

progressive signs-
Slurred speech
Disorientation
Seizures

Cardiovascular:
Widened PR interval
Wide QRS
Sinus tachycardia
Ultimately cardiovascular collapse

7

treatment of local anesthetic toxicity

oxygen airway support

If seizure does not terminate spontaneously:
Benzodiazepine (medazepam)
Or
Thiopental

cardiovascular support may be needed

Intralipid for Marcaine/ bupivacaine

8

workup for insulinoma and CT scan shows multiple lesions and pancreas

portal venous sampling for localization of highest functional tumors

9

management of zone one injury

Central-
Diaphragm to sacrum
Renal hilum lateral
contained colon
Aorta
Vena cava
Portal vein
Proximal renal vessels
Anchors
Duodenum

Both penetrating and blood injuries with hematoma should be explored surgically

10

Zone 2 retroperitoneal injury

lateral

Renal hilum
Kidneys
Adrenals
Superior ureters

Blunt injuries and hematoma did not need to be explored

Left associated colon injury, urinoma, expanding hematoma

Stone to penetrating injuries with hematoma are explored

11

Zone 3 retroperitoneal injury

inferior central - pelvis
Iliac vessels
Rectum
Distal sigmoid
Distal ureters

Stable non-expanding hematomas nonoperative

Hematomas from penetrating injury may need exploration

12

structures at risk with inferior esophageal mobilization for fundoplication

vagus nerve
Left hepatic artery coming from the left gastric can be encountered

13

Minor salivary gland tumors most common locations

90% malignant

Palate is the most common origin 50%

lip 15%

buccal mucosa 12%

tongue and floor of mouth 5%

14

minor salivary gland tumor tissue type in presentation

most
adenoid cystic carcinoma

signs of malignancy:

rapid tumor growth
Pain
Ulceration

15

Treatment of minor salivary gland tumor

surgical resection with adequate margins

Conclusion:
Involved mucosa
Muscle
Bone

postoperative radiation if:
high grade
positive margins
Perineural spread
Deep invasion into muscle bone
Lymph nodes
Metastases

16

what hormone is responsible for secretion of bicarbonate and stomach passes food into duodenum

secretary and

causes increased bicarbonate decreased chloride

17

Heineke-Mikulicz Strictureplasty indications and procedure

Crohn's stricture
strictures up to 5-7 cm long
Longitudinal incision over stricture closed transversely

18

Finney strictureplasty indications and procedure

strictures up to 10-15 cm long

loop of stricture as doubled and incised and closed as functional side to side

19

diagnosis and young female on oral birth control pills with 6 cm liver lesion

hepatic adenoma

20

imaging findings of hepatic adenoma

early phase enhancement

21

the management of hepatic adenoma

symptomatic resect

Asymptomatic adenomas stopped oral contraception and followup

Resect before planned pregnancy

22

boundary of the femoral canal

anterior chest inguinal ligament
Posterior pectineal ligament
Medial lacunar ligament
Lateral femoral vein

23

what invasive maneuver often needs to be performed for management of femoral hernia

division of inguinal ligament to fully reduce the herniated bowel

24

splenic septated cyst workup and treatment

most common parasitic source:
echinococcus!

serology
splenectomy

25

asymptomatic non-parasitic splenic cyst

observed with ultrasound followed

Risk of cyst rupture even with minor trauma when large cyst

Small symptomatic non-parasitic cyst may be excised with a splenic preservation

26

Cancer most likely to metastasize the spleen

along

27

primary tumor most likely to be found and spleen

sarcoma

28

ischemic reperfusion injury after renal transplant

presentation maybe a 36 hours

acute tubular necrosis

treated with fluid resuscitation

may require dialysis

29

test to confirm vascular occlusion after renal transplant

radioisotope scanning and ultrasound

30

disseminated intravascular coagulation

causes:
Trauma
Hemodialysis
Obstetric
Malignancy
Sepsis

thrombin and plasma INCREASE
causes bleeding and clot formation

Antithrombin III and plasminogen levels DECREASE

31

bacteria associated with emphysematous gallbladder and diabetes

Clostridium perfringens

32

Paget Von Schroeder syndrome

venous thoracic outlet syndrome
Effort thrombosis

Narrowing of the subclavian AXILLARY vein

At the level of the costoclavicular space

Most medial aspect of thoracic outlet

Sources of compression:
First rate
Clavicle
Subclavius
Costal coracoid ligament
Anterior scalene
Tubercle

If emboli occur: ARTERIAL

33

described first-degree burn

painful
Erythema
Blanche

34

Describes second-degree superficial burn

superficial dermis

Painful
Erythema
Blanche
blister

35

described deep second-degree burn

deep dermis

Painful
Do not blanch
Pale
Mottled

36

described third-degree burn

subcutaneous fat

heart
Left artery
Eschar
PAINLESS
Black, White or RED

37

tetralogy of fallot findings

overriding aorta
VSD
Right ventricular outflow obstruction
Right ventricular hypertrophy

38

Management of irreducible inguinal hernia in newborn found to have ischemic bowel-operative approach

Our section can usually be performed through hernia sac!

39

Most common location and anatomy a hepatic artery And course

and celiac trunk
Superior edge of the pancreas
Gastroduodenal artery
Right gastric artery
Courses into portal triad
bifurcates into right and left

40

common variant of left hepatic artery

off of left gastric

41

localization studies insulinomas

EUS
CT scan - 40%-still done
intraoperative ultrasound most sensitive (careful, gastrinoma not that useful)

Also continues calcium angiography-calcium stimulates increase in tone secretion

42

criteria to diagnosis primary hyperparathyroidism

increased PTH
Increase calcium
Normal or elevated urine calcium (differentiate from familial hypercalcemic hypocalciuria)

chloride- phosphorus ratio: 33:1

43

superior vena cava syndrome

diagnosis CT
Bronchoscopy biopsy

Treatment:
Chemoradiation

surgery rarely possible due to great vessel involvement

44

CMV colitis

immunocompromised
Bloody diarrhea
Endoscopy with biopsy confirms

Treatment ganciclovir

Resection considered only with life-threatening ischemia or uncontrolled bleeding
Or
Peritonitis

45

Normal right ventricular pressure
appearance on EKG

20-30/0-8
square roots sign

46

normal pulmonary artery wedge pressure
appearance on EKG

6-15
smooth curves with low amplitude
loss of Dicrotic notch

47

mechanism of action of heparin

indirect thrombin inhibitor

ACCELERATES antithrombin III activity

48

aspirin mechanism

irreversible cyclooxygenase inhibitor

49

electrolyte abnormality seen after full resuscitation of burn

HYPER natremia
even though LR

50

lactated Ringer's contains

sodium 130
Chloride 109
Lactate 28
Potassium 4
Calcium 3

51

normal saline containing

sodium 154
Chloride 154
osmolarity of 308 mOsmol/L
Ascitic! PH 5.5

52

for epidemiology of trauma what our host, Vector, environment

Host-human
Vector-vehicle
Environment

53

primary spread of T1 adenocarcinoma esophagus

submucosal

54

treatment of N1 adenocarcinoma esophagus

en bloc resection

55

treatment of Merkel cell carcinoma

wide excision

Sentinel node for all

Radiation for all

56

Innervation of cricothyroid

external branches superior laryngeal nerve

57

innervation of hypopharynx

glossopharyngeal cranial nerve 9 and vagus nerve cranial nerve 10

58

course of superior laryngeal nerve

off the vagus and exit skull

This ends internal carotid artery

Divided hilar cartilage into internal and external branches

59

internal branch of superior laryngeal nerve

lateral thyroid membrane

Sensory after her fibers from the supraglottis and vocal folds

60

external branch of the superior laryngeal nerve

inferior constrictor anterior medial course

Along with the superior thyroid artery

Into the cricothyroid muscle-motor innervation

Separate from superior thyroid artery 1 cm proximal to arterial entrance of capsule superior pole thyroid

61

transposition of great vessels

associated:
VSD
Hypoplastic aortic arch


Cyanotic

Treatment FIRST with prostaglandin E. to keep ductus arteriosus OPEN

balloon septostomy can also help

death if untreated

62

increase risk of ovarian cancer

pain breast with estrogen exposure

including not breast-feeding

Family history of:
Colon
Breast
Endometrial

high-dose ovulation induction

peroneal talc use!

63

decrease risk of ovarian cancer

oral birth control

Tubal ligation

64

minimal alveolar concentration

alveolar concentration of inhaled anesthetic required to prevent movement and 50% of patients to noxious stimuli

65

initial trauma fluid bolus pediatric

20 mL per kilogram x2
then blood

66

inotropic agent used for pediatric sepsis that's different then adults

epinephrine more commonly used and kids

67

stage IV sarcoma of the extremity

with regional node involvement!
any metastases

68

what lab finding is seen with 21 hydroxylase deficiency

incr 17-OH progesterone
(careful, don't confused with 17-hydroxylse deficiency)

21 hydroxylase def salt wasting

69

most common at risk structure with posterior shoulder dislocation

axillary artery

70

signs of posterior shoulder dislocation

fixed internal rotation

X-ray findings may be so because humeral head directly posterior on AP view

CT scan most helpful

71

Treatment of posterior shoulder dislocation

immobilization and external rotation

Rate presentation requires open reduction

72

Structure at risk with anterior shoulder dislocation

axillary nerve

73

transanal excision of rectal cancer criteria

Local excision of a rectal cancer may be appropriate for a small cancer in the distal rectum that has not penetrated into the muscularis.

mobile tumors smaller than 4 cm in diameter, that involve less than 40% of the rectal wall circumference, and that are located within 6 cm of the anal verge. These tumors should be stage T1 (limited to the submucosa) or T2 (limited to the muscularis propria), well or moderately differentiated histologically, and with no vascular or lymphatic invasion.

74

sphincter relationship required for LAR

tumor greater than 2 cm from the sphincter muscle

the sphincter involved:
APR

75

rectal cancer approach that lower stent and postoperative complications

total mesorectal excision

76

criteria to transfuse platelets for ITP Undergoing surgery

only for significant bleeding

Alternative:
platelets less than 20 -
IV immunoglobulin x2 days

77

common cause of bleeding after Whipple- was treated in

gastroduodenal stump blowout - often caused by gastrointestinal anastomosis leak

embolization via hepatic artery

78

fetal circulation

oxygenated blood from placenta was into SINGLE umbilical vein

And 2 IVC

From right atrium to left atrium through the foramen ovale

and from right ventricle to pulmonary artery shunted through ductus arteriosus to aorta

de and oxygenated blood return to consent to be 2 umbilical arteries that come off internal iliac

79

contraindications to using nitrous oxide

small bowel obstruction

80

most common complication of renal stone And how can just be related to bowel resection

calcium phosphate

terminal ileum resection causes increased resorption of oxalate in the colon that is excreted in the urine

81

initial blood pressure management in the ascending thoracic aortic dissection

beta blocker
labetalol or propranolol

pressure remained above 100 pigmentation add nitroprusside

82

what is contraindicated in spinal cord injury

succinyl choline

hyperkalemia

also avoided in turn

83

cardiac findings with hyperkalemia

PVCs
Wide complex tachycardia
Torsade de pointes
Cardiac arrest

84

half life of insulin

7-10 minutes

85

Insulin response to oral glucose versus IV

or glucose much greater response increase of insulin

86

pleomorphic adenoma presentation and treatment

most common benign tumor of the salivary glands

90% of the parotid gland
superficial facial nerve
superficial parotidectomy

87

most common site of aspiration in the lung

right

88

treatment of one aspiration

most commonly antibiotics

If not cleared in 8 weeks surgery

Surgery indications:
Large cavities over 4-6 cm
Hemoptysis
Need to rule out malignancy

89

physiologic functions of parathyroid hormone

Inhibits calcium excretion distal convoluted tubules the kidney

Inhibits phosphate reabsorption
inhibits bicarbonate reabsorption

stimulates vitamin D production and kidneys

stimulated vitamin D conversion to active form



90

operative approach for open treatment of the Zenker's diverticulum

LEFT neck

91

when is a myotomy alone sufficient to treat Zenker's

diverticulum less than 2 cm

pexy of the diverticulum not needed

92

criteria for endoscopic Zenker's

2-5 cm diverticula
though can be performed less than 3 cm - the surgery is better when less than 3 cm in size

93

Most common source of metastasis found in the small bowel

melanoma

94

pulmonary artery occlusion pressure the indicates achieved blood volume expansion

stabilization between 15-20

95

Purpose of using vasopressin and shock

treatment vasodilatory shock refractory to the infusion of alpha adrenergic agents alone

96

Central cord injury

upper extremity weaker than lower extremity

patchy sensation

loss of reflexes

Mid to low cervical spine

history of spinal stenosis

Hyperextension

97

anterior cord injury

infarction

Complete paralysis below injury

Preserved sensory from posterior column

98

posterior cord injury

complete paralysis and loss of proprioception

loss of vibration

intact pain temperature and light touch

99

Brown-Séquard syndrome

ipsilateral motor loss

Contralateral pain loss

Contralateral temperature loss

100

imaging findings of hemangioma

most common benign tumors of the liver
(careful common not adenoma)

peripheral enhancement on arterial phase

'out grows blood supply'

asymptomatic managed conservatively

101

imaging findings of adenoma the liver

well circumscribed
heterogeneous

early enhancement an arterial phase

102

where is greatest risk of placing tacks with laparoscopic inguinal hernia repair

inferior to inguinal ligament
Lateral to epigastrics

risk:
Femoral branch of general femoral nerve
Lateral femoral cutaneous nerve
Spermatic vessels
Vas deferens

103

first line treatment of endometriosis

oral birth control pills

Estrogen inhibitor such as danazol

definitive treatment hysterectomy

104

action of CCK

gallbladder activity

released from duodenum
stimulated by:
Fat
Needle acid
Ascitic environment

Contracts gallbladder
RELAXES the sphincter of Odie

105

Courvoisier's sign

enlarged palpable gallbladder in patients with obstructive jaundice caused by tumors of biliary tree or pancreatic head tumors

106

what size umbilical hernia as expected to close spontaneously in children

less than 2 cm

107

type of immune response with hypersensitivity

type I

Anaphylaxis

108

type II immune reaction

and a body IgG IgM

Hemolytic anemia

109

type III immune reaction

antibody antigen complex

Serum sickness

110

type 4 immune reaction

peak response 24-72 hours

Contact dermatitis

PPD

111

CCK is released by work cells and where

I cells duodenum

112

treatment for parathyroid cancer

en bloc resection
Total parathyroidectomy
ipsilateral thyroidectomy

113

workup for refractory hypertension

working diagnosis of primary hyperaldosteronism:
Plasma aldosterone to plasma renin ratio 30

Absolute aldosterone 15

24 hour urine aldosterone

CT scan

CT scan unsuccessful:
Adrenal sampling-to not necessary in patient's older than 40 with solitary adrenal mass greater than 1 cm and normal contralateral gland

114

adrenal sampling positive

for times greater aldosterone to cortisol level on one side

115

most common site of cervical cancer node metastases

internal iliac nodes

116

most common site of endometrial lymphatic drainage

this is different from cervical drainage

Retroperitoneum:
Para-aortic nodes

117

next best step in management for effort induced thrombosis

catheter directed thrombolysis
which has a high rate of restoring luminal patency

( careful, initial treatment used to be anticoagulation alone)

after pain patency reestablished catheter directed thrombolysis then do first rib possibly and same hospitalization



118

Most important criteria to predict tolerating the pulmonary lobectomy

FEV1 greater than 0.8

other criteria:
PCO2 not greater than 45-50

DLCO Diffusion capacity not less than 40%

VO2 exercise tolerance not less than 10-12 mL/minute / of kilogram

119

the FEV1 borderline with his next test to predict tolerating the pulmonary lobectomy

VQ scan

shows distribution of ventilation blood flow to each lobe

120

CT finding of epidural hematoma

biconvex bordered by cranial suture lines
lenticular
location between skull and dura

Arterial injury

Lucid interval

121

Acute subdural hematoma findings compared to chronic

biconcave crescent-shaped crossing over lateral suture but does not cross midline ( because of presence of falx)

tearing or bridging veins

Location between arachnoid dura mater

careful, chronic subdural fade to the density of the CSF

122

lab findings of primary hyperparathyroidism

increase calcium
Decrease phosphorus
Increased PTH
Normal or INCREASED urine calcium

123

diagnosis with diabetes associated with dermatitis-migratory

GLUCOGONoma

necrolytic migratory erythema

124

location of VIPomas

body and tail

125

location of gastrinoma in pancreas

body and tail

same as VIPoma

126

diagnosis and treatment of glucagonoma

serum glucagon levels usually greater than 500

preoperative colon
Controlled diabetes, octreotide

Debulking

127

treatment of abscess superior to dentate line

most common type of fistula

No external opening-Mae tract to rectal wall
We tracked to lower rectum
Passes within in the intersphincteric space

treatment:
Must find crypt or abscess originated-
Endoscopy, probing, sigmoidoscopy that's rule out Crohn's

The internal opening found-drained or fistulotomy

Approach may require incising mucosa and longitudinal internal sphincter muscle of rectal wall

Antibiotics none needed once drained

128

cancer associated with vinyl chloride exposure

hepatic ANGIOSARCOMA

129

colovesical fistulas more common in men or wome with diverticulitis

man because uterus acts as barrier

130

pathophysiology of developing gastroischesis

associated with normal involution of the second umbilical vein

131

anesthesia agents associated with malignant hyperthermia

inhaled volatile
depolarizing muscle relaxant

132

earliest sign of malignant hyperthermia

tachypnea
Tachycardia
Hypertension
Increased end tidal CO2

other findings:
Hyperkalemia
Acidosis

133

mechanisms dantrolene

muscle relaxant

Blocks excitation contraction coupling of muscle cells

134

Cantile's line

IVC and gallbladder

135

segments of left liver

2
3
4

136

most lateral segments of the left liver

2 and 3

137

most posterior segments of right liver

6 and 7

138

right shift of oxygen saturation curve

the decrease his oxygen affinity
with increase release to tissue

" right his right"

increased temperature
increase pCO2
increased to 2,3-DPG - helps unload o2
DECREASED pH (increase acid)
hypoxia
carbon monoxide decreases P50 of hemoglobin

139

left shift of oxygen saturation curve

more tightly bound worse for tissue

decrease temperature
Decreased pCO2
Decrease 2,3 DPG
INCREASED pH (decreased acid)

fetal hemoglobin

140

presentation and CT findings of pancreatic lymphoma

bulky mass
Surrounding lymphadenopathy
- increased LDH
normal bilirubin

absence:
Weight loss
Extrahepatic biliary obstruction
elevated bilirubin

EUS biopsy confirms

NO surgery for lymphoma

Treatment:
chemotherapy



141

criteria for resection for cure of pancreatic adenocarcinoma

Resectable tumors are defined as localized to the pancreas, with no evidence of SMV or portal vein involvement (i.e., no abutment, distortion, thrombus, or encasement) and a preserved fat plane surrounding the SMA and celiac artery branches, including the hepatic artery. Patients with imaging consistent with resectable disease should proceed with operative resection.

only regional lymph nodes are still considered operative management

field of resection, ascites, or vascular involvement beyond the borderline 180 dgr incasement

142

pancreatic adenocarcinoma defines borderline resectable as tumors that exhibit one of the following characteristics:

(1) severe unilateral or bilateral SMV-portal impingement; (2) less than 180-degree tumor abutment on the SMA; (3) abutment or encasement of hepatic artery, if reconstructible; and (4) SMV occlusion, if of a short segment, and reconstructible

143

Adjuvant chemo for pancreatic adenocarcinoma

Current NCCN guidelines continue to recommend gemcitabine or 5-FU alone, or in combination with 5-FU– based chemoradiation, as adjuvant treatment following resection for PDAC

144

neoadjuvant chemoradiation pancreatic adenocarcinoma

no studies have shown an improvement in overall survival for patients who receive neoadjuvant chemotherapy and radiation.

For individuals with significant SMV–portal vein involvement (>180 degrees or short-segment encasement), or hepatic arterial or SMA abutment (<180 degrees) who have been traditionally considered unresectable, neoadjuvant therapy may play an important role in identifying the subset of patients most likely to derive benefit from aggressive multimodality therapy, including surgical resection with vascular reconstruction.[51] This type of aggressive treatment should be undertaken only by an experienced multidisciplinary team in the setting of a clinical trial

145

ASA classification

one-normal healthy
2 - mild systemic disease
3-severe systemic disease
4-severe systemic disease that is consistent with threat to life (unstable angina)
5-morbnd patient does not expected to survive without intervention
6-brain-dead

lack of any adjustment and intubation difficulty

146

lab findings of hemophilia A.

prolonged PTT
Normal PT and bleeding time

147

Intraoperative choices to administer and bleeding hemophilia A in order of preference

cryoprecipitate:
factor 8 and fibrinogen

148

Reed-Sternberg cells

associated with lymphoma

149

HeinZ bodies

the nature to hemoglobin

150

target cells

immature cells the increasing number

151

pappenheimer bodies

iron granules seen increasing after splenectomy

152

cell mediated immunity

T. cell mediated response
initiate CD4 and CD8 lymphocyte

pathogens targeted:
Virus
Fungus
protozoans
INTRAcellular bacteria

but not good old fashion bacteria like a Haemophilus influenza

153

indications for emergency discectomy of vertebrae

cauda equina syndrome only indication for urgent

154

condition of ovarian torsion

initial venous and lymphatic obstruction
Cyanotic edematous ovary

Progresses to low-grade fever and leukocytosis with adnexal necrosis

Doppler

155

Primary common duct stones

most common primary bile duct stone composition is calcium bilirubinate

pigmented in colon
Block-excess bilirubin due to hemolysis

Brown-de congregation of bilirubin by bacteria, Escherichia coli precipitates and calcium bilirubinate

156

most common nerve injured and laparoscopic hernia repair

Genital femoral

Lateral femoral cutaneous

157

most common nerve injury with open inguinal hernia repair

ilioinguinal

Genital branch of general femoral ( careful, most common in laparoscopy is genital femoral)

Iliohypogastric

158

testicular tumor consistent with AFP or beta hCG and LDH elevation

nonseminomatous germ cell tumor

159

testicular tumor consistent with beta hCG elevated only

10-20% seminoma

careful, AFP never elevated with seminoma

160

management of lower moderate grade dysplasia of Barrett's

endoscopy every 3-6 months

161

rollover fundoplication when Barrett's is diagnosed

if low or moderate:

Fundoplication can stop progression but will not reverse Barrett's

162

presentation of nasopharyngeal carcinoma

ear infections in Caucasian elderly male
with tobacco history

Nasal obstruction

Conductive hearing loss

163

Indications for urgent surgical intervention gunshot wound of the kidney

renal pedicle avulsion - life-saving nephrectomy
expanding hematoma
un contained retroperitoneal hematoma
shock

relative indication:
Large amount of devitalized renal parenchyma

does not mandate surgical repair:
Urine extravasation!
most lacerations are to minor calyces and stopped spontaneously

workup for urine extravasation-
Serial CT scan

164

diagnosis of nutcracker esophagus

manometry amplitude greater than 180
contraction greater than 6 seconds

normal progressive contraction on esophagram

hyperperistalsis on EGD

165

esophageal pathology with corkscrew esophagus

diffuse esophageal spasm

careful, amplitude normal on manometry

166

contraindications ketamine

myocardial disease
brain lesion
(Downs ok)

Increase myocardial oxygen consumption

Increased intracranial pressure

167

advantage full-thickness skin graft

less contracture

poor take rate

168

advantage split thickness skin graft

left vulnerable to shear force

To be placed directly over muscle flap

169

ct finding of pyogenic absces

rim enhancing and gas bubbles

170

Uncal herniation early signs

cranial nerve III which causes early findings of anisocoria, ptosis, impaired extraocular movements, and sluggish pupillary light reflex on the ipsilateral side of the lesion. Initially

171

Cervical cancer with nodal spread tx

Stage IIIB lesion with a poor prognosi

(Advanced stage tumors are defined as IIB-IVA)

Radiation therapy and chemotherapy, not surgery, are the primary treatment modality for advanced cervical cancer.

172

physiologic leukocytosis of pregnancy, which may be as high as

16,000 cells/mm3.

173

what his more common in the small bowel primary tumor or metastatic tumor

metastatic

Most common met melanoma

174

list cancer that metastasized to small bowel

melanoma #1 extra-abdominal source

intra-abdominal sources more common overall:
Cervix
Ovaries
Kidneys
Stomach
Colon
Pancreas

175

mechanism of amiodarone

in addition of the breakdown of cyclic AMP
phosphodiesterase inhibitor

INCREASE his calcium uptake-increased contractility

also vasodilator

176

most common cause of bleeding from pelvic fracture and zone 3 hematoma

sacroiliac joint associated arterial bleeding

Usually branch of the internal iliac artery

177

embolized for pelvic bleed with fracture

The incidence of arterial hemorrhage amenable to embolization is approximately 10%. In these cases, arteriography with embolization can be lifesaving.

disruption of the sacroiliac (SI) joint, female gender, and duration of hypotension were all predictors of a positive angiogram

178

T. stage colon cancer

1 invasive submucosa
2 today's muscularis propria
3 through muscularis propria and into pericolic rectal tissue
4a to surface of visceral peritoneum the
4b invades visceroperitoneum

179

n-stage colorectal adenocarcinoma

N1 1-3 regional nodes

N1a one regional node
N1b 2-3 regional nodes
N1c without regional nodes:
but with:
deposits in the subserosa, mesentery, non-peritonealized pericolic or perirectal tissue

N2a 4-6 nodes
N2b 7 or greater

180

pancreatic divisum

failure of fusion of the ventral and dorsal pancreatic ducts

usually asymptomatic

treated with ERCP and sphincteroplasty with sten

duct of Wirsung still drained via major papilla:
drains uncinate process and part of pancreas head

Duct of Santorini:
still draining to be a lesser papilla
drains head, body, tail

diagnoses ERCP

181

primary pulmonary hypertension

idiopathic

Aggressive and often fatal

182

duodenal atresia

double bubble

Down's syndrome, maternal polyhydramnios, malrotation, annular pancreas, biliary atresia, cardiac, esophageal, renal, anorectal
VACTRL

distal to anterior levator-biliary emesis

Its distal areas still seen after double bubble need upper GI contrast exclude midgut volvulus

treatment:
Duodenal duodenostomy
either side to side or transverse to distal longitudinal diamond-shaped

183

went blood work findings are seen with complete asplenia

Howell-Jolly bodies - no more spleen to filter is out

184

work up for accessory spleen postsplenectomy



Howell-Jolly bodies - no more spleen to filter is out

radionucleotide image 2 located accessory spleen

185

best test for pheochromocytoma

For pheochromocytoma, the most sensitive markers are serum metanephrines and normetanephrines, which are the breakdown products of circulating catecholamines. If the serum metanephrines are twice the normal level or higher, the patient has a pheochromocytoma;

Do not make the mistake of ordering serum catecholamines, as their rapid fluctuations render them useless. If the result of the serum metanephrines leaves the diagnosis in doubt, a 24 hour urine collection for metanephrines, catecholamines, and vanillylmandelic acid should be ordered. While the sensitivity of this test remains above 95%, it also has better than 95% specificity.

186

choledochocyst type I

fusiform dilation common bile duct

Most common

Cholecystectomy and hepatico J.

187

choledochocyst type II

EXTRA hepatic
diverticular cyst

Cholecystectomy and hepatico J.

188

choledochocyst type III

Distal to common bile duct - Junction with duodenum

cholecystectomy
Resection
Choledochoduodenostomy

189

choledochocyst type IV

BOTH intrahepatic and extrahepatic

May require liver resection of involved segment

190

choledochocyst type V

INTRA-hepatic

May be to liver failure - In which case transplant is treatment

191

refractory hypertension 6 months post renal transplant

transplant renal artery stenosis

workup may include:
Color Doppler ultrasound
MR angiography ( Better than CT)
spiral CT

treatment:
Percutaneous transluminal angioplasty

192

most common type of hip dislocation

Posterior dislocations compose 70-80% of all hip dislocations and 90% of all sports-related hip dislocations.

193

most common type of shoulder dislocation

ANTERIOR

he clinical presentation of anterior hip dislocation is characterized by abduction and external rotation. Anterior dislocation of the hip, although less common, is more frequently associated with fracture of the femoral head or indentation deformation. Large femoral head fractures and those associated with acetabular or femoral neck fractures have a high incidence of avascular necrosis and hip arthritis

Posterior dislocations compose 70-80% of all hip dislocations and 90% of all sports-related hip dislocations.

194

Posterior hip dislocations

Posterior hip dislocations are much more common than anterior dislocations

classically present with an adducted, flexed, and internally rotated extremity (choice A).

195

stimulate the LES

Alpha-adrenergic neurotransmitters or beta-blockers stimulate the LES,

gastrin and motilin

196

stimulants decrease in pressure of LES

alpha blockers and beta stimulants decrease its pressure.

cholecystokinin, estrogen, glucagon, progesterone, somatostatin, and secretin decrease LES pressure

197

when vecuronium elim decreased

renal or hepatic dysfunction

198

what effects Cisatracurium elim

Hoggman elimination
also seen with atracurium

good choices if the patient has hepatic or renal failure

199

requirements for endovascular aneurysm repair

aortic neck length greater than 1.5 cm
Neck angulation less than 60°
landing zone greater than 1 cm

200

type I endoleak

around graft at proximal or distal attachment

201

Type II endoleak

Retrograde collateral branch

Lumbar, testicular, inferior mesenteric

202

Type III endoleak

Between different parts of components

203

Type IV endoleak

2 graft wall

204

Type V endoleak

Unknown origin

205

Breslow stage

this is the pure depth in millimeters stage

stronger predictor of outcome and Clark's

Products probability of lymph node involvement and five-year survival

206

treatment of stage III colon adenocarcinoma

Stage III colon cancers benefit from adjuvant chemotherapy. Following resection, the recommended chemotherapy regimen is with 5-FU, Leucovorin, and Oxaliplatin. This is known as the FOLFOX therapy, and has shown to increase survival in patients with Stage III colon cancer.

207

chest tube output and hemothorax that mandates operative intervention

greater than 1500 mL Initial

Persistent drainage of 200-100 mL per hour for 4 hours after initial drainage

208

what is the plasma carrier of cholesterol

LDL

209

diagnosis of solitary lung mass with popcorn calcification

hamartoma

Benign

210

Workup for suspected hemobilia

first endoscopy - Rules out other sources

angioma and embolectomy definitive

most minor hemobilia is managed conservatively

211

what is most potent hormone to stimulates pancreatic enzyme secretion

CCK

stimulated by a release of fatty acid and polypeptide and duodenum

212

normal location for anal fissure

posterior

lateral need workup for Crohn's or STI

213

diseases that splenectomy cure

hereditary cytosis
NON-Hodgkin's lymphoma
CLL with symptomatic splenomegaly

214

C-peptide finding with insulinoma

high

C-peptide is endogenous

215

mechanism of aldosterone

increase sodium retention and distal tubule

stimulated by angiotensin II the

216

mechanism of angiotensin II

convert angiotensin I to angiotensin II didn't stimulate release of aldosterone

217

mechanism of Renin

convert angiotensin edge and angiotensin I

stimulated by low-sodium and distal convoluted tubule, hyperkalemia, hypovolemia

218

diagnosis during laparoscopy sudden decrease in end-tidal CO2 and hypotension

CO2 embolus

219

management of familial hypercalcemia hypocalciuria

no treatment indicated

hypercalcemia usually mild

220

defects associated with maternal polyhydramnios

tracheoesophageal fistula
Duodenal atresia

221

mechanism of jejunal atresia

intrauterine mesenteric vascular accident

222

mechanism of gastroischesis

failed obliteration of umbilical vein

223

medications contraindicated in obstructive hypertrophy cardiomyopathy

dopamine #1 no no
inotrope causes further decreasing cardiac filling and worsens ventricular outflow tract obstruction

224

medications for obstructive hypertrophy cardiomyopathy

beta blocker - metoprolol first line
calcium channel blocker

slow down and relax heart to improve filling

amiodarone helps decrease arrhythmia potential

225

risk factors a squamous cell carcinoma head and neck

Tobacco
Alcohol
HPV
Epstein-Barr virus

226

immune functions IgA

intestinal tract

Produced by plasma cell

Findings antigen
Negative bacteria
Prevent colonization
Neutralize his toxin
Works against virus


DOES NOT work with optimization