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MIX 6 QBANK Flashcards

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1
Q

findings associated with Crohn’s disease compared ulcerative colitis

A 
rectal sparing
Granulomas
Ulcerations
Seizures
Fistulous
The abscess
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2
Q

differentiate hypertrophic scar versus keloid

A

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
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3
Q

mechanism of calcitonin

A

stimulated by high calcium level

para follicular cells of the THYROID

opposes PTH

increases excretion of phosphorus

inhibit osteoclasts

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4
Q

blood supply of gastric conduit

A

RIGHT is right

gastroepiploic

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5
Q

name trends of immuno drugs

A

inib - inhibitory

mumab = fully human

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6
Q

Hypermagnesemia

A

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

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7
Q

Hypokalemia symptoms include

A

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.

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8
Q

Actions and CCK

A 
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

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9
Q

causes of torsades de pointes

A

prolonged QT interval 500 msec or longer
hypokalemia
hypomagnesemia
renal failure

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10
Q

treatment of torsades the points

A

correct electrolytes

Increased heart rate - This shortened the ventricular repolarization

Magnesium sulfate

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11
Q

T-cell mediated rejection of the liver transplant

A

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

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12
Q

findings seen on chronic rejection of liver

A

increased total bilirubin
Increased alkaline phosphatase

Vanishing bile duct syndrome

Lymphocytic direct attacks on biliary ducts

No treatment except retransplantation

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13
Q

Treatment of post liver transplant biliary leak

A

a initial management nonoperative:

ERCP and stent

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14
Q

treatment of Graves disease possible complications

A

radioactive iodine

may make proptosis worse

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15
Q

vagus nerve innervated

A 
epiglottis
The larynx 
 trachea
Bronchi
 lung
Esophagus
 heart
Stomach
 mesentery
Bowel
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16
Q

workup for suspected blunt cardiac injury

A

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

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17
Q

recommendations for treatment of C. difficile

A

mild to moderate:
Flagyl

recurrent:
Flagyl

severe case:
Vancomycin

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18
Q

management of hepatic artery aneurysm

A

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

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19
Q

Reduction maneuver for posterior hip dislocation

A

opposite of defect:
Traction
Abduction
external rotation

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20
Q

associated injury with posterior hip dislocation

A

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

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21
Q

supracondylar fracture of the humerus associated injury

A

brachial artery

Volkmann’s contracture

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22
Q

distal radius associated injury

A

median nerve compression

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23
Q

anterior dislocation the shoulder associated injury

A

axillary nerve injury

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24
Q

histologic depth of deep second-degree burn

A

reticular dermis

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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

QBANK MIX (28 decks)

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