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MIX 5 QBANK Flashcards

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1
Q

Erythropoietin adult versus fetal source
stimulation
Mechanism
Side effects

A

adult kidney
Fetal liver

stimulation:
Hypoxia

asked on bone marrow

side effects:
Hypertension
Hypercoagulable

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2
Q

success rate of hydrostatic intussusception reduction and recurrence

A

80%

10%-usually within 24 hours

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3
Q

diagnosis intussusception

A

physical exam plain film

If diagnosis in question ultrasound

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4
Q

the most common site of intussusception in kids

A

ileocecal lymphadenopathy

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5
Q

number of recurrences before surgery for intussusception and kids

A

2 or more

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6
Q

advantages carotid artery stenting versus open carotid endarterectomy

A

CAS more beneficial with better outcmes when:
asymptomatic
recurrent carotid stenosis
history of neck irradiation.
with severe medical comorbidities, such as three-vessel coronary artery disease
chronic obstructive pulmonary disease (COPD)

disadvantages of stent:
significantly higher stroke rate in the CAS arm of the study
risk of restenosis higher with stent

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7
Q

management of asymptomatic 50-69% stenosis in patient with multiple vessel disease and needs CABG

A

CABG only

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8
Q

when is polypectomy is sufficient and what his followup

A

even malignant polyps invasion limited to head or neck

Repeat colonoscopy 3 years

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9
Q

when he is segmental resection needed with polyp characteristics of the bowel

A 
greater than 3 cm
Sessile
Lymphovascular invasion
Invasion into stalk
Poorly differentiated
Margin less than 2 mm
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10
Q

what are considered germ cell tumors of the testicle

A

seminoma and non-seminoma

“non-germcell”:Leydig cel, Sertoli cell, gonadoblastoma

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11
Q

management of solid mass seen on ultrasound and the testicle

A

ALL patient’s get:
Inguinal radical orchiectomy

with CT study for staging
retroperitoneal and lung

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12
Q

most common sites of testicular cancer metastasis left versus right

A

left= periaortic

right= Intra-aortocaval nodes

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13
Q

most significant indicator for malignant potential of GIST of small bowel

A

greater than 5 mitoses per high power field

greater than 5 cm

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14
Q

findings with VIPoma

A

WDHA
watery diarrhea
hypokalemia
Achlorhydria

metabolic acidosis-careful, no chloride - but lost bicarbonate from diarrhea

distal pancreas

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15
Q

Workup for VIPoma

A

VIP May need to be measured multiple times and serum

EUS is most sensitive

CT scan localizes most

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16
Q

symptom management of VIPoma

A

octreotide and can help with diarrhea and lytes

palliative debulking can sometimes improve symptoms

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17
Q

or pancreatic endocrine tumor is associated with diabetes

A

glucagonoma
AND
Somatostatinoma

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18
Q

and appeared treatment with mucopurulent cervicitis

A

chlamydia
gonorrhea

Treatment of trichomonas and bacterial vaginosis should be reserved for when these diseases are detected

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19
Q

Signs of adrenal insufficiency

A 
hyperpigmentation -  a PTH induced
Hypotension
Hyponatremia
HYPERkalemia
 weight loss
 nausea vomiting
 abdominal pain
 weakness
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20
Q

most potent stimulator of bile secretion

A 
CCK-
Stimulates pancreatic enzyme secretion
  		Stimulates gallbladder contraction
  		Relaxes sphincter of Oddi
  		Inhibits gastric emptying

Cholecystokinin (CCK), secreted by the intestinal mucosa, serves to induce biliary tree secretion and gallbladder wall contraction, thereby augmenting excretion of bile into the intestines.

secretin
Stimulates release of water and bicarbonate from pancreatic ductal cells

Stimulates flow and alkalinity of bile
Inhibits gastric acid secretion and motility and inhibits gastrin release

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21
Q

T stage for hepatocellular carcinoma

A

T1-no vascular invasion any size, solitary
T2-solitary tumor any size with vascular invasion
or
multiple tumors all less than 5 cm
T3-multiple tumors greater than 5 cm
or
invasion in the major branch of portal or hepatic veins
T4-invasion into organs - or perforates visceral peritoneum
BUT the gallbladder does not count

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22
Q

with anatomic artery variance can come directly off of the innominate artery

A

thyroid ima -

which can supply both medial aspects of both lobes of the thyroid

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23
Q

ligamentum arteriosum anatomy

A

superior surface of the pulmonary artery and the inferior surface of the aortic arch. It is a nonfunctional vestige of the ductus arteriosus, and is formed within three weeks of birth.

left recurrent laryngeal nerve, a branch of the left vagus nerve.

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24
Q

absolute contraindications to laparoscopic splenectomy for ITP

A

cirrhosis
Pregnancy
poor cardiopulmonary status

Splenomegaly is not a contraindication

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25
to most common malignant tumor of the parotid gland
mucoepidermoid carcinoma
26
management of mucoepidermoid carcinoma parotid gland
high-grade: Highly aggressive Total parotidectomy RADICAL neck dissection Postop radiation therapy regardless of nodes prepared for an extended, radical parotidectomy, which may involve resection of overlying skin, adjacent mandible and soft tissue, temporal bone, and a portion of the adjacent external ear. With advanced presentations, the facial nerve is invariably sacrificed in these patients; free tissue transfer may be necessary for repair.
27
most common malignancy of the submandibular gland
adenoid cystic carcinoma (parotid a second most common site) high rate of perineural invasion
28
Treatment of adenoid cystic carcinoma
most common site submandibular gland Perineural spread, Treatment: Radical resection Sacrificing nerves only for direct tumor extension Postoperative radiation
29
most common benign lesion of major salivary glands
pleomorphic adenoma the may have pseudopods extension beyond apparent borders of mass-high recurrence but not necessarily malignant transformation
30
Treatment of pleomorphic adenoma
Resection of tumor within a margin of normal gland surrounding it Superficial parotidectomy classic treatment Findings the facial nerve identified and preserved at with complete tumor extirpation
31
Warthin's tumor
``` tail of parotid typically benign cystic Multicentric Temperature bilateral ``` Treatment: Superficial parotidectomy-somewhat a pleomorphic adenoma
32
Indications for radical neck dissection
all high grade malignant tumors or parotid gland (Even with negative nodes on exam) Squamous cell carcinoma of the prostate gland
33
were present volume of blood can be lost in pregnant female before showing signs of shock
35%
34
normal cardiac index
2.5-4.5
35
normal the stomach vascular resistence
1000 -1500
36
trend and pulmonary artery catheterization with cardiac tamponade
equalization and diastolic pressures
37
first abnormality usually seen in MEN 1
hypercalcemia
38
her most common pancreas tumor overall in MEN1
to nonfunctional pancreatic neuroendocrine tumor or secretin pancreatic polypeptide most common functional neuroendocrine tumor is gastrinoma
39
signs of Zollinger-Ellison syndrome
GERD Circuitry diarrhea Weight loss
40
pancreas pathology associated with lymphoplasmacytic infiltration
chronic autoimmune pancreatitis
41
Volkmann's contracture
associated with splinting in acute flexion occludes neurovascular structures ( brachial artery the supracondylar) Compartment syndrome-fibrosis
42
origin and course of the right coronary artery
right coronary sinus anterior surface of heart In atrioventricular groove supplies right ventricle
43
branches the right coronary artery
90%: Posterior descending artery Right posterior lateral artery this pattern is right dominant 90%: Branches to AV node 50%: Branches to S-A node
44
most common origin of coronary circumflex artery
right coronary artery
45
seborrheic keratosis as a risk factor for what
nothing
46
skin lesion that is risk factor for squamous cell carcinoma
actinic keratosis (Careful, NOT seborrheic keratosis) Chronic draining sinus Burn scar
47
with topical burn antibiotics with a sulfa
Silvadene-silver sulfadiazine mafenide acetate-Sulfamylon
48
subacute thyroiditis thyroid function findings
none
49
symptoms of TTP
``` thrombotic thrombocytopenic purpura FATRN Fever Anemia Thrombocytopenic purpura Renal failure Neuro-mental status ```
50
medical treatment of TTP
anti platelet-aspirin dipyridamole FFP can be helpful Plasmapheresis Corticosteroid
51
splenectomy for TTP
failed medical management Decrease mortality long-term
52
Salivary gland tumors treated with superficial parotidectomy
Warthin's tumor Pleomorphic adenoma ( unless malignant)
53
treatment of SIADH with small stable intracranial hemorrhage
fluid restriction
54
laboratory findings of SIADH
hyponatremia LOW serum osmolality HIGH urine osmolality
55
treatment of stress incontinence with decrease bladder contraction
intermittent self catheter NOT cholinergic - Urecholine
56
management of diverticular abscess percutaneous drainage not available
laparoscopic drainage
57
other symptoms with thoracic aortic aneurysm
Compressive: hoarseness Dyspnea Early satiety
58
newborn presents with severe respiratory distress hyperlucency left thorax, chest tube causes further decompensation diagnosis and treatment
congenital lobar emphysema Immediate thoracotomy and lobectomy mistaken for pneumothorax with an appropriate chest tube placement Positive pressure ventilation contraindicated If asymptomatic can observe
59
Difference between mean in median
mean of the average: data points added then divided by a number of data points median is that either lives in the center of the data points when there are arranged and numerical order - also known as 50th percentile
60
effect of PTH and vitamin D
PTH increases renal synthesis of calcitriol - the hormonally active form of vitamin D this increases intestinal obstruction of calcium
61
effect of PTH on phosphorus
blocks reabsorption and proximal and distal tubules
62
diagnosis of cholangiocarcinoma
Adenocarcinoma of the bile ducts ultrasound for intrahepatic MRI for extrahepatic cameron and says no invasive cholangiogram A chest radiograph is sufficient evaluation for pulmonary metastases. The role of PET/CT was discussed previously; judicious use is reasonable based on the current data In a healthy patient with resectable disease and a total bilirubin less than 10 mg/dL, ideal treatment would be resection without any biliary intervention. .
63
treatment of cholangiocarcinoma
complete resection, which typically requires en bloc hepatectomy. Thus, resection is appropriate for medically fit patients without extrabiliary disease. The presence of metastases, either intrahepatic or within regional lymph nodes outside the hepatoduodenal ligament, is a contraindication to resection nvolvement of the distal common bile duct margin necessitates the addition of a pancreaticoduodenectomy. A Roux-en-Y hepaticojejunostomy brought into the right upper quadrant through a retrocolic mesenteric defect allows restoration of bilioenteric continuity.
64
presentation a blind loop syndrome
Crohn's patient with obstruction Steatorrhea, diarrhea, megaloblastic anemia, and malnutrition are the hallmarks of blind loop syndrome.
65
treatment of cystadenoma of the appendix
appendectomy alone - do not biopsy because risks rupture which can cause pseudomyxoma peritonei careful, this is DIFFERENT from cystadenocarcinoma - that is treated with right hemicolectomy
66
causes of pancreatic ascites
pancreatic duct disruption | Leaking pseudocyst
67
Treatment of pancreatic ascites
Initial colon N.p.o., nasogastric drainage, somatostatin Possible paracentesis 50% respond to conservative management 2-3 weeks persistent: ERCP demonstrated site of duct disruption Resection if in tail Or Roux-en-Y drainage for leaks and head and neck NOT stent
68
pancreaticopleural fistula
Dr. disruption usually posterior Careful, pancreatic juice traveled cephalad through retroperitoneum to reach thorax
69
the management of arrhythmia is persistent despite pulling pulmonary catheter back
lidocaine were other antiarrhythmic
70
detail and plane film the esophageal atresia does not also have tracheoesophageal fistula
tracheoesophageal fistula who present with air and the intestine
71
where it is peripheral artery disease developed in smoking and atherosclerosis
proximal vessels
72
melanoma with worst prognosis
nodular Aggressive vertical phase Early distant metastases
73
contraindication to Arixtra
renal failure Primarily excreted by kidneys
74
absolute indications for IVC filter
thromboembolic disease with a contraindication to anticoagulation or complication or failure of anticoagulation
75
management of ischemic orchitis after inguinal hernia repair postop day 5
nonsteroidal anti-inflammatory Causes venous congestion from pampiniform plexus and thrombosis Possible ligation of testicular artery during repair Present days 2-5 postop
76
minimize his risk of ischemic orchitis with inguinal hernia repair
excessive dissection of spermatic cord
77
at the tumor marker for granulosa cell ovarian cancer
"Inhibin" ( may be falsely positive in premenopausal) careful, CA 125 - his marker for girdle fashion epithelial ovarian cancer
78
Indications for ED thoracotomy
penetrating chest trauma the signs of life in the field witnessed loss of pulses
79
signs of life:
``` Ventilation Carotid pulse Measurable blood pressure Extremity movement - Not DTRs pupillary reactivity Cardiac electrical activity ```
80
thoracic penetrating trauma with best survival rate with ED thoracotomy
cardiac
81
principle type of collagen in the skin and bone
type I
82
inflammatory phase of wound healing
separate from proliferative phase increased vascular permeability Migration of cells by chemotherapy Secretions sided times and growth factors Activation of migraine cells
83
principal event of proliferative days
collagen deposition cross-linking occurs provides tensile strength formation of granulation tissue
84
complication risk with EBV after transplant
post transplant lymphoproliferative disease
85
consultation risk of HHV-8 post transplant
Kaposi's sarcoma
86
indications for tetanus
``` tetanus prone wound: Gross devitalized tissue Obvious contamination Frostbite Missile injury Injury over 6 hours old ``` Do not require tetanus toxoid if: any night within past 5 years Received 3 or more doses of toxoid Requires tetanus immunoglobulin: Tetanus prone Immune status is partial or UNKNOWN
87
most common bacteria isolated from perforated appendicitis
Escherichia coli | Bacteroides fragilis
88
what his time. When remodeling phase of wound healing begins - and what take place
last stage III weeks Last up to 1 year converts type III collagen to type I collagen
89
with mechanism of small cell lung cancer causing Cushing's syndrome
ACTH | does not suppressed with dexamethasone
90
upper chest causes of Cushing syndrome
neuroendocrine tumor Or Bronchogenic malignancy
91
most common site of injury to the biliary system during cholecystectomy
CBD | RIGHT hepatic duct
92
pathophysiology on the in-line level of acute pancreatitis
injury begins in a Acinar cells intraosseous muscle activation of colon zymogens Including trypsinogen Cathepsin-B can activate zymogens
93
blood supply of hepatic metastases
hepatic artery
94
advantage of chemotherapy embolization of her systemic chemotherapy
better response Lower side effect Extraction rate 90% High local concentration This is adjuvant therapy does not resulting cure
95
at its beta hCG threshold to determine intrauterine pregnancy
1500 - 2000
96
diagnosis of ectopic pregnancy
empty uterus Beta-hCG higher than 1500 this may also be seen with early pregnancy
97
define Culdocentesis
Fluid sampled from cul-de-sac of Douglas test rarely performed to assess bleeding
98
Cullen's sign
can be seen an ectopic pregnancy superficial edema and bruising and subcutaneous fatty tissue around the umbilicus
99
candidate for medical management of ectopic pregnancy
not ruptured - Ruptured is emergent operation beta-hCG less than 15,000 fetus less than 3.5 cm compliant patient No intrauterine pregnancy

QBANK MIX (28 decks)

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