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Flashcards in MIX 6 QBANK Deck (93):
1

findings associated with Crohn's disease compared ulcerative colitis

rectal sparing
Granulomas
Ulcerations
Seizures
Fistulous
The abscess

2

differentiate hypertrophic scar versus keloid

both itchy


hypertrophic scars:
developed in 6-8 weeks
increased density or blood vessels
increased myofiberblasts
subside with time
maintained boundaries of original scar
associated with closing wound under tension

keloid,
Developed months after injury
DECREASED density of blood vessels
NO myofiberblasts
they do not regress
grow outside of boundaries

3

mechanism of calcitonin

stimulated by high calcium level

para follicular cells of the THYROID

opposes PTH

increases excretion of phosphorus

inhibit osteoclasts

4

blood supply of gastric conduit

RIGHT is right
gastroepiploic

5

name trends of immuno drugs

inib - inhibitory
mumab = fully human

6

Hypermagnesemia

characterized by loss of deep tendon reflexes, paralysis, coma, hypotension and cardiac arrest. It may follow burn or crush injuries.

7

Hypokalemia symptoms include

paresthesia, weakness and flaccid paralysis. It may progress to cause ventricular fibrillation and cardiac arrest. Causes are numerous and include decreased renal function, ACE inhibitor medications, succinylcholine, and ischemia-reperfusion injury.

8

Actions and CCK

gallbladder contraction
Sphincter of Odie relaxation
Pancreatic enzyme stimulation
Inhibits gastric emptying
NOT related to bicarbonate

release from duodenum and jejunum
I cells

stimulated by fat, polypeptide, amino acid

9

causes of torsades de pointes

prolonged QT interval 500 msec or longer
hypokalemia
hypomagnesemia
renal failure

10

treatment of torsades the points

correct electrolytes

Increased heart rate - This shortened the ventricular repolarization

Magnesium sulfate

11

T-cell mediated rejection of the liver transplant

Most common time of presentation his first 10 days

30-50% within the first 6 months

treatment is increasing immunosuppression

unlike renal transplant does not affect overall graft survival!

Pathology findings:
Leukocytosis, eosinophilia, malaise

biopsy:
Portal leukocytosis, and ileitis, bile duct infiltration and damage

12

findings seen on chronic rejection of liver

increased total bilirubin
Increased alkaline phosphatase

Vanishing bile duct syndrome

Lymphocytic direct attacks on biliary ducts

No treatment except retransplantation

13

Treatment of post liver transplant biliary leak

a initial management nonoperative:
ERCP and stent

14

treatment of Graves disease possible complications

radioactive iodine

may make proptosis worse

15

vagus nerve innervated

epiglottis
The larynx
trachea
Bronchi
lung
Esophagus
heart
Stomach
mesentery
Bowel

16

workup for suspected blunt cardiac injury

admission and followup in our EKG on suspected

admission EKG normal:
workup can be terminated

to have normal colon
Cardiac monitoring 24-48 hours

If unstable hemodynamic:
Echo - 2 transthoracic first batch is suboptimal, transesophageal

sternal fracture does not mandate continuous monitoring and EKG is normal - but if present and may suspect blunt cardiac injury and requires admission EKG

Troponin and CPK-MB not helpful

to her her to the

17

recommendations for treatment of C. difficile

mild to moderate:
Flagyl

recurrent:
Flagyl

severe case:
Vancomycin

18

management of hepatic artery aneurysm

require intervention:
2 cm or greater
Rupture
Symptomatic

Common hepatic artery aneurysm:
Ligation or embolization only
ONLY bypass if:
Whipple ( no GDA)
no ligation if:
cirrhosis-ischemic compromise and encephalopathy

proper hepatic artery:
Requires bypass - GDA is proximal to this lesion


19

Reduction maneuver for posterior hip dislocation

opposite of defect:
Traction
Abduction
external rotation

20

associated injury with posterior hip dislocation

sciatic nerve
Femoral nerve
Obturator nerve ( careful, don't confuse the obturator artery)
with

21

supracondylar fracture of the humerus associated injury

brachial artery
Volkmann's contracture

22

distal radius associated injury

median nerve compression

23

anterior dislocation the shoulder associated injury

axillary nerve injury

24

histologic depth of deep second-degree burn

reticular dermis

25

weighted criteria for fistulotomy with intersphincteric fistula

minimally involvement of the external anal sphincter

26

when is a seton indicated

transsphincteric fistula

presumably involved external sphincter

27

initial management of transposition of the great vessels

keep PDA open:
PGE1 (prostaglandin)

This provided left to right shunt and improve symptoms


28

Definitive management of transposition of the great vessels

balloon atrial septoplasty percutaneously through umbilical or femoral vein

allows atrial mixing

Then discontinue prostaglandin

29

common associated injury with trauma splenectomy

pancreatic tail injury

30

plasma free metanephrine test

Pheochromocytoma

High sensitivity: 99%
Lower specificity: 85%
( rules out patient's one positive because positive is positive)
but if negative, still unsure:
so need a 24-hour urine



31

24-hour urine metanephrine test

very high specificity and sensitivity

32

which imaging studies better to study anatomy of pheochromocytoma

CT is better than MRI!

33

Given example ordinal data

tumor stage

inherent order but interval between stages may vary

considered qualitative

34

measures of central tendency

mean, median, mode

titrated for continuous data

35

what type of data as needed for student t teest

continuous data
Measures and central tendency

36

What type of days need for Chi-square test

binary

37

what is responsible for wound contraction

myo fibroblasts

38

was responsible for collagen production

fibroblasts

39

diagnosis and treatment algorithm for effort induced venous thrombosis

duplex ultrasound

if acute presentation:
Venogram basilic vein document extensive thrombus begin thrombolysis

heparinized also administered..

for followup venogram to confirm persistent thrombus


First rib resection for decompression

40

when the sentinel lymph node biopsy indicated for melanoma

clinically negative nodes because if positive will do lymph node dissection

Tumor thickness created 1 mm

or tumor thickness was less than 1 mm when:
Ulceration
Regression
Greater than 1 mitoses per 10 high-power field

Clark's level IV and V

41

what is at level III axillary node dissection landmark

medial to pectoralis minor

42

normal physiologic trigger to release secretin

acid and duodenum

43

functions secretin

increase bicarbonate release from pancreas

This neutralized with acid chyme

Inhibits:
gastric release
Acid secretion
Gastric motility
( goals of digestion and mixing)



44

what is considered a positive separate and stimulation test

increase in serum gastrin greater than 200 above basal level

45

In the rare case that surgery is performed for Ogilvie syndrome what is approach

usually cecostomy for external decompression

rectal tube is ineffective

46

laboratory determination of ARDS and requirements

PaO2/FiO2: LESS than 200

and exclusion of cardiogenic pulmonary edema must be possible

47

Swan-Ganz pulmonary artery wedge pressure that would rule out cardiogenic pulmonary edema

less than 18

48

best test to evaluate history of vomiting epigastric abdominal pain without peritonitis or vital sign concerns

Boerhaave syndrome

Gastrografin esophagram

If negative colon
Endoscopy to definitively rule out perforation

49

describe rapid sequence intubation in order

preoxygenated - 3 minutes ( to 8 minutes before apnea and de saturation less than 90%)
Fentanyl - protects with cardiovascular disease from catecholamine surge and
Etomidate
Succinylcholine
Extension

50

list the renal hilum structures from anterior to posterior

renal vein
Renal artery
Ureter/renal pelvis

51

Adson test for thoracic outlet syndrome

also called scalene test

neck extension turned head towards the ipsilateral effected extremity

Ipsilateral radial pulse disappears when positive

52

antibiotic of choice with PID abscess

clindamycin penetrates abscess

Also add aminoglycoside

53

treatment of GIST

1- 2 cm margin
Wedge resection adequate
Did not need node resection

Adjuvant Gleevac:
3 cm or greater
5 or greater mitoses per 50 high-power field

unresectable:
Gleevac



54

indications for neoadjuvant Gleevac

possibly unresectable tumors or large tumors
extensive organ involvement
Duodenal
rectal
near the gastric esophageal junction and the

55

greatest risk factor for GIST malignancy

risk factors for malignancy are tumor size larger than 10 cm and more than five mitoses/50 HPF.

56

followup after GIST excision and treatment

post excision
CT scan every 3-6 months for the first 5 years!
then annual

This is for tumors probably greater than 2 cm

57

management of GIST recurrent

surgeries better

Gleevec usually has maximal response by 2-6 months

58

management of penetrating chest injury with acute cardiac tympanod unstable

left thoracotomy ED

59

primary actions of calcitonin

decrease PTH
Decrease phosphorus level because of renal excretion is increased

60

wet portion of the colon has the greatest absorption

proximal colon
needle water fast
over 1 L a day

61

most common malignancy of the appendix

adenocarcinoma

careful, most common tumor of the appendix as carcinoid-not all carcinoid or malignant

62

mucinous cystadenoma of the appendix benign or malignant

benign

63

cancer that can metastasize to the appendix

breast cancer
Colon cancer
General tract

64

Treatment of hepatorenal syndrome

because of cirrhosis, hypervolemia is associated with intravascular DECREASED fluid

treatment fluid

can improve after liver transplant

65

what lobes at the oblique fissure separate

middle from lower

66

way lobes of the minor fissure separate

upper from middle

67

ratio of bile salts, cholesterol, phospholipid lecithin associated with gallstone

to high value constituents can be seen with one low value constituent informed stones

cholesterol component is dependent on either substances can be low stones

high bile salt and high possible lipid with a low-cholesterol can cause gallstones

68

symptoms of hyponatremia

confusion 2 seizure

Muscle fatigue or cramps

Nausea vomiting

69

hypercalcemia symptoms and associations

nausea vomiting
Diarrhea

Weakness confusion

Psychoses
Kidney stones

associated:
Prolonged immobilization
Granulomatous disease
Dyazide
Malignancy
Hyperparathyroidism

70

hypermagnesemia symptoms and associations

LOSS of deep tendon reflex

Paralysis

Coma

HYPO-tension

Cardiac arrest

Association colon
Burn
Crush

71

what needs to be monitored when getting thrombolytic

fibrinogen level

TPA causes hypofibrinogenemia

72

r disseminated intravascular coagulation relationship to thrombin

excess thrombin: Marker of this is split products were d-dimer

73

mechanism of refeeding syndrome and presentation with laboratory findings

rapid substrate to chronically depleted system overwhelmed ATP metabolism

Decrease:
phosphorus
Potassium
Magnesium

symptoms:
Nausea vomiting
Weakness With the muscle spasticity
Technique
Cardiac arrhythmias including arrest after ectopy

74

Treatment of refeeding syndrome

decreased calories especially glucose

Replace electrolytes - which will not work and that she decrease calories

75

absolute contraindication to thrombolytics

active internal bleeding
Within 2 months of:
Cerebrovascular accident
intracranial surgery
Spinal surgery
Intracranial neoplasm
Uncontrolled hypertension severe
Uncontrollable clotting disorder
Previous allergy

76

Relative contraindications to thrombolytic

within 10 days of:
Operation or obstetrical
Procedure site that is noncompressible (example, gastrointestinal, cardiopulmonary, possibly central line)
Left heart thrombus
Subacute bacterial endocarditis
Severe liver kidney disease
Diabetic retinal hemorrhage
Acute pancreatitis
Urgency


heparin is ARE not contraindication-often used to prevent propagation of clot including effort induced thrombosis

77

Diagnosis with malignant epithelial cells from parotid mass with nerve symptoms

mucoid epidermoid carcinoma


most common MALIGNANT neoplasm of the parotid for both adults and children

78

findings of multi-nodular goiter T3-T4 and ultrasound

elevated T3
Decrease T4

Ultrasound:
5 nodules greater than 1 cm
3 nodules less than 1 cm

79

Treatment of of the nodular goiter

FNA

Iodine supplement over time - careful, can precipitate thyrotoxicosis

levothyroxin mainstay treatment 80% decrease goiter with this

Thyroidectomy if:
Increase nodule size
Nodules too numerous to perform FNA

NOT radio iodine ablation ( the treatment for Graves' disease)

80

What is iodine-131 methyliodobenzylguanidine (I-131 MIBIG) used to localize

adrenal pheochromocytoma

taken up and chromic and tissue

81

test for Aldosteronoma

adrenal vein sampling

82

test for insulinoma

endoscopic ultrasound

remember, octreotide not helpful

83

localization study for gastrinoma

somatostatin (octreotide) scan/scintigraphy

84

where due to renal arteries come off of the aorta compared other vessels

just below SMA

L2

85

Relationship the right renal artery to IVC

under IVC on the way to kidney

86

relationship of renal arteries to renal veins

renal vein anterior

87

relationship or renal artery to ureters and renal pelvis

anterior to ureters plus pelvis

88

initial treatment for ITP

steroids are only indicated if patient does symptomatically bleeding

or platelet count falls below 30,000

patient's

89

treatment of ITP patient with acute active bleed

IVIG

90

3 indications for IVIG and ITP

acute active bleed

Preoperative

Before childbirth

91

when his splenectomy indicated for ITP

failed medical management

Platelet count remains under 30,000 after 3 months of maximal treatment

92

cervical intraepithelial neoplasia definition

CIN

PRE-malignant
identified on Pap smear

93

cervical intraepithelial neoplasia treatment algorithm

mild dysplasia:
CIN-1
Often secondary to infection
Observe

Moderate-severe dysplasia
CIN-1-2
cryoablation or electrosurgical excision