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Flashcards in MIX 5 QBANK Deck (99):
1

Erythropoietin adult versus fetal source
stimulation
Mechanism
Side effects

adult kidney
Fetal liver

stimulation:
Hypoxia

asked on bone marrow

side effects:
Hypertension
Hypercoagulable

2

success rate of hydrostatic intussusception reduction and recurrence

80%

10%-usually within 24 hours

3

diagnosis intussusception

physical exam plain film

If diagnosis in question ultrasound

4

the most common site of intussusception in kids

ileocecal lymphadenopathy

5

number of recurrences before surgery for intussusception and kids

2 or more

6

advantages carotid artery stenting versus open carotid endarterectomy

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

7

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

CABG only

8

when is polypectomy is sufficient and what his followup

even malignant polyps invasion limited to head or neck

Repeat colonoscopy 3 years

9

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

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

10

what are considered germ cell tumors of the testicle

seminoma and non-seminoma

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

11

management of solid mass seen on ultrasound and the testicle

ALL patient's get:
Inguinal radical orchiectomy

with CT study for staging
retroperitoneal and lung

12

most common sites of testicular cancer metastasis left versus right

left= periaortic
right= Intra-aortocaval nodes

13

most significant indicator for malignant potential of GIST of small bowel

greater than 5 mitoses per high power field
greater than 5 cm

14

findings with VIPoma

WDHA
watery diarrhea
hypokalemia
Achlorhydria

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

distal pancreas



15

Workup for VIPoma

VIP May need to be measured multiple times and serum

EUS is most sensitive

CT scan localizes most

16

symptom management of VIPoma

octreotide and can help with diarrhea and lytes

palliative debulking can sometimes improve symptoms

17

or pancreatic endocrine tumor is associated with diabetes

glucagonoma
AND
Somatostatinoma

18

and appeared treatment with mucopurulent cervicitis

chlamydia
gonorrhea

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

19

Signs of adrenal insufficiency

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

20

most potent stimulator of bile secretion

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

21

T stage for hepatocellular carcinoma

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

22

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

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

23

ligamentum arteriosum anatomy

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.

24

absolute contraindications to laparoscopic splenectomy for ITP

cirrhosis
Pregnancy
poor cardiopulmonary status

Splenomegaly is not a contraindication

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