MIX 7 QBANK Flashcards Preview

QBANK MIX > MIX 7 QBANK > Flashcards

Flashcards in MIX 7 QBANK Deck (121):
1

treatment of bladder cancer transitional cell carcinoma

tumor confined to mucosal:
T1
Resection was intravesical BCG

Invades the muscle:
Radical cystectomy
Abdomen or neoadjuvant chemotherapy

2

brown common bile duct stones

associated with infection of biliary

3

black common bile duct stones

associated with hemolysis

Unconjugated bilirubin

Sickle cell

Hereditary spherocytosis

4

which usually presents first in MEN syndromes pheo or thyroid

thyroid

5

compared sporadic to hereditary pheochromocytomas

hereditary pheochromocytoma:
Earlier age
Multiple
Bilateral
Extruded renal
RARELY malignant


6

best test for pheochromocytoma workup

PLASMA free metanephrine best test to exclude Pheochromocytoma (Cam- recent finding)

24-hour urine:
Catecholamines
Fractionated metanephrines
Vanillylmadelic acid

7

screening for hypercortisolism


low dose overnight dexamethasone suppression test 95% sensitive

24-hour urine free cortisol next at

if positive test for:
ACTH - tests for adrenal versus, pituitary, versus ectopic site

(Cam)

evening salivary cortisol maybe (Qbank)

8

survival of patient with mechanical valve versus bioprosthetic valve

equal

with bioprosthetic valve wears out faster

9

anticoagulation of mechanical valve versus bioprosthetic valve

mechanical-yes

Bioprosthetic-no

10

When should ventral hernia with mesh seroma be drained

persistent over 6-8 weeks

11

treatment of esophageal cancer perforation with contained leak versus free perforation

contained leak may consider antibiotics and observation

12

unusual causes of urgent esophagectomy

cancer
Achalasia
Severe peptic strictures
Caustic injury

Esophagectomy regardless of degree of inflammation or interval..

13

the the most common in a natural history of ASD

most are small and do not present symptoms until adulthood

Adult symptoms:
Dyspnea
Shortness of breath
Heart murmur

14

Cystic hygroma

benign fluid collection of lymph

Accumulated posterior neck most commonly

she seen on prenatal ultrasound

Treatment:
Observe

Surgery if -
Airway compromise
Infected
Hemorrhage

If risk to adjacent structures may consider injecting sclerosis

15

complication seen with nitroprusside

sign of toxicity

Pulmonary edema
Weakness confusion

Diagnosis: Thiocyanate level

Treatment:
Amyl nitrate
Sodium nitrite
Sodium thiosulfate

16

adverse effect of halothane

ventricular arrhythmia

Rarely hepatic necrosis

17

metabolism of sevoflurane

hepatic

18

advantages of isoflurane

vasodilator
Least myocardial depression ( but second-best when compared to nitrous oxide)

19

Enflurane vascular defects

also peripheral vasodilator

but more myocardia depression and isoflurane

20

effects of prostacyclin on platelet

inhibit platelet aggregation and is also a vasodilator

PGE1
prostaglandin analogs such as alprostadil or misoprostol (prostaglandin E1 analogs)
keeps PDA open

21

defined P. value when related to null hypophysis

probability of obtaining a result as extreme (or more extreme) than the one observed if the null hypothesis is true.

22

fluid status of SIADH patient

euvolemic
low urine sodium

23

fluid status cerebral salt wasting

hypovolemic

24

venous capacitance

somewhat analogous to vascular resistance but whereas vascular resistance relates to flow through a blood vessel, vascular capacitance relates to the volume contained in it.

The relationship between the volume of blood contained within a segment of vasculature and the pressure distending the vascular walls over a wide range of pressures and volumes. The veins of the body are not only conduits for the return of blood to the right heart, but they also determine most of the vascular capacitance and contain most of the blood volume. Changes in vascular capacitance provide a quick and effective mechanism for the filling of the right heart,

25

prognosticators for poor survival with extremity sarcoma

tumor size
High grade
Deep location
subtype:
1.Leiomyosarcoma
2.malignant peripheral nerve tumor
Symptoms recurrent disease
positive margins

these are different from prognostic factors for local or distant recurrence

26

factors at increased local recurrence in extremities soft tissue sarcoma

age
Recurrent disease
Positive margins
subtype:
1. fibrosarcoma ( careful, this is not included having increasing for survival)
2. peripheral nerve tumor - this is shared with risk factors of survival

27

factor to increase distant recurrence and extremity soft tissue sarcoma

same as for prognosis but include:
non liposarcoma

tumor size
High grade
Deep location
subtype:
1.Leiomyosarcoma
2.malignant peripheral nerve tumor
Symptoms recurrent disease
positive margins

these are different from prognostic factors for local or distant recurrence

28

what else is given other than dantrolene for malignant hyperthermia

insulin
Bicarbonate

29

physiologic effects of somatostatinoma

jaundice-inhibits pancreatic and biliary secretions
also present in proximal head of pancreas and ampulla
Gallstones
Diabetes-inhibition of insulin secretion
steatorrhea

30

diagnosis and treatment of somatostatinoma

somatostatin level greater than 10

attempt at complete excision as well as cholecystectomy

31

skin findings with what pancreatic tumor

glucagonoma

sticky itchy sugar skin

treat with amino acid

32

initial study of choice for suspected esophageal perforation with mediastinal findings on chest x-ray after Nissen

Gastrografin first in case there is a leak in the stomach as well

careful, barium is better for the chest

33

explaining why tamoxifen decreases estrogen breast and increase his risk of uterine cancer

Tamoxifen, a selective estrogen receptor modifier (SERM) although labeled as an antiestrogen, acts as a weak estrogen in some tissues. It is inhibitory in breast tissue, yet stimulatory in the endometrium

34

ABCD rule skin cancer


higher cancer risk.

A – Asymmetry,
B – irregular Border,
C – nonuniform Color,
D – Diameter > 6 mm.

35

management of squamous cell carcinoma the neck unknown primary

radiation of oropharynx and bilateral neck

36

Most common site of origin of squamous cell carcinoma the neck with unknown primary

80% from oropharynx

Most common tonsil involved is ipsilateral

However, its base of tongue need bilateral node radiation

37

diagnostic tests can be used to differentiate between a pituitary secreting adenoma and ectopic ACTH production

high dose dexamethasone suppression test

38

workup for Cushing's

24-hour he urine free cortisol
Elevated: Probable Cushing's syndrome

----------------
ACTH:
Present

pituitary MRI and high dose dexamethasone suppression:
mass-transsphenoidal pituitary microsurgery

no mass:
Bilateral inferior petrosal sinus sample-
gradient found:
Transsphenoidal pituitary microsurgery

no gradient found:
Chest abdominal CT
Somatostatin receptor scintigraphy

-------------
ACTH not present:

CT of the adrenals

------------------

24-hour urine frequent result negative (x2):
late evening salivary cortisol x2

if positive: ACTH operative

if negative: Cushing's unlikely

39

does ACTH with pituitary source of Cushing's suppressed with high dose dexamethasone

YES

ectopic does not suppress

40

NASCET trial

symptomatic

Greater than 70% stenosis

at 2 years:
Surgery group 9% stroke
Medical group 26% stroke

41

ACAS Trial

asymptomatic

greater than 60% stenosis

at 5 years:
Surgery group 5% stroke
Medical group 11% stroke

42

because of urinary retention after hemorrhage surgery

muscle spasm pelvic floor

NOT lidocaine

43

paraneoplastic syndrome associated with small cell lung cancer

ACTH
SIADH

The a's are the smallest letter of the alphabet
ACTH
ADH

44

or perineoplastic syndrome was associated with a squamous cell of the lung

parathyroid hormone related peptide

45

medication use for pulmonary hypertension

milrinone

Viagra

46

pressor used to maintain brain heart and kidney perfusion

dopamine

inotropic support in order to maintain brain, heart, and kidney perfusion.


increased heart rate, increased contractility, and peripheral vasoconstriction

47

effects of high dose dopamine

off adrenergic

Can cause significant coronary vasoconstriction-angina increased pulmonary hypertension

48

vessel effects with nitroglycerin

artery and venous smooth muscle dilator

primarily increased venous capacitance

higher doses relaxed arterial tone

49

vessel effects with hydralazine

arterial vasodilation - peripheral

50

nerves at risk and distal to external iliac artery laparoscopic hernia repair

Gen. femoral

lateral femoral cutaneous

51

multiple to initiate extravasation of leukocytes from blood vessel causing them to roll on endothelium

E-selectin

ICAM-1 is a second stab

TNFa also involved

52

neural control of the external anal sphincter

voluntary

Branches of the internal pudendal
AND
S4

53

to management of duodenal obstruction first portion of the duodenum with Crohn's

Gastro-J. bypass

stricturoplasty does not work well in here

54

would have and the venous capacitance and septic shock

increases

55

movement is a diaphragmatic injury repaired abdominally versus thoracic

abdominally within first week

Thoracic and chronic

56

Best outcome for peripheral angioplasty patency

iliac

worsens distally

57

incision for proximal control of the innominate artery

MEDIAN sternotomy

58

structures accessible from median sternotomy

descending aorta
Aortic arch
Innominate
Right subclavian
LEFT common carotid

59

structures accessible from supraclavicular or infraclavicular incision

axillary artery
Subclavian artery

Does not allow for control of innominate coming off the aorta

60

incision exposure for left subclavian proximal control

third interspace anterior thoracotomy

61

Milan Criteria

appropriate candidate for transplant with hepatocellular carcinoma

Single lesion less than 5 cm

2-3 lesions each less than 3 cm

no major vessel involvement

no extrahepatic metastases

62

blood to the esophagus

cervical-subclavian, thyrocervical trunk, inferior thyroid

Thoracic- aorta branches

abdominal- LEFT GASTRIC artery

63

symptoms of mitral valve stenosis - with what workup findings in what presentation

normal bile 4-6 cm

severe stenosis :
less than 1 cm
gradient greater than 10

increased left atrial pressure 25
Pulmonary hypertension
pulmonary edema
secondary right heart failure
JVD

NOT synchope seen with aortic stenosis

64

position of anterior hip dislocation and complication

ABducted
EXTERNALLY rotated
Femoral head overlying obturator foramen

avascular necrosis

65

most common cause of postcholecystectomy bile leak

loss clip from the cystic duct after inflammation
(qbank did not consider this technical)

66

management of duct of Luscha bile leak after cholecystectomy

ALSO with stent

67

vitamin C pathway of collagen synth and what other constituents are required

hydroxylation of lysine and Prolene

as well as cross-link

iron
alpha ketoglutarate

68

4 leg compartments

anterior - greatest risk of compartment syndrome
Lateral
Superficial posterior
The posterior

69

border of return of function of GI system Post operation

small bowel hours
Stomach 24-48 hours
Colon 48-72 hours

70

diagnosis with corkscrew esophagus

diffuse esophageal spasm

71

management of diffuse esophageal spasm

medical
Endoscopic bougie dilatation - 70-80% success

long esophageal myotomy for refractory entire length of esophagus when abnormal manometry is confirmed

72

antibiotic for fight bite including alternatives and penicillin allergy

amoxicillin clavulanic acid

other choices:

pipercillin tazobactam
cefotetan
cefoxitin

penicillin allergy:
Doxycycline

73

Most common bacteria human bite

Bacteroides
produce beta-lactamase

E. Corrodens
Corynebacterium - common in human bite-gram-positive rod

74

flow velocities by stenosis: 50%, 50-69%, greater than 70%

less than 50%-125 cm/s
50-69%-100-230 cm/s
greater than 70%-greater than 230 cm/s

75

significant calcifications and pulmonary nodule

BENIGN

Careful, thyroid and breast calcifications concerning for cancer

76

pulmonary lesion doubling time associated with cancer

one month one year

over one year more likely benign

77

criteria to follow only with plain film chest x-ray no CT scan for pulmonary nodule

less than 5 mm and:
Smooth borders

78

risk of lung cancer with nodule over 50-year-old

50%!
Associated with some malignancy

79

standard of care for a patient with metastatic renal cell carcinoma

neoadjuvant nephrectomy
Interleukin-2 and interferon

80

contraindications to use ketamine

elevated intracranial pressure-increases cerebral blood flow

Open eye injuries and eye disorders increase his intraocular pressure

Ischemic heart disease-increases rate and blood pressure-increased myocardial oxygen consumption

toxic administered in epidural

81

characteristics of malignant pheochromocytoma

neuroectodermal tissue found and locations bed does not demonstrate this tissue normally

axial skeleton
Nodes
Liver
Lungs
Kidneys

82

muscle resection that improves exposure common carotid artery

omohyoid

83

muscle resection improved exposure of the internal carotid artery

the digastric

84

most important prognosticator of soft tissue sarcoma of the extremity

mycotic index-histology - amount of necrosis



85

when his chemotherapy helpful and soft tissue sarcoma

possibly Ewing sarcoma

other soft tissue sarcomas of the extremities treated with radiation as first choice for adjuvant

86

most common genetic defect and colon cancer

APC gene

Careful, this is also seen in FAP

87

most common organism to cause overwhelming postsplenectomy infection

Streptococcus pneumoniae-90% cases overall

88

treatment if pituitary surgery has failed and continued Cushing's

second attempt resection

or

postoperative radiation may improve remission rates if surgery failed

bilateral adrenalectomy - last resort

89

success of curing Cushing's syndrome with adrenalectomy

90%!

90

Excessive tearing Cushing's disease with pituitary adenoma microsurgery

75%

91

GCS

none
stim
Voice
Spontaneous

None
Incomprehensible
inappropriate
Confused
Oriented

none
Decerebrate
Decorticate
Withdrawal
Localize
Comand

92

treatment of threatened extremity from embolus with a recent MI

thrombolytic

Gen. anesthesia relative contraindication to embolectomy

93

amount of fluid that can be seen on chest x-ray

300 mL

94

whereas most of the pulmonary fluid resorbed

PARIETAL pleura has most the lymphatics

95

pleural serum ratio of protein consistent with transudate

no
less than 0.5?

96

Concomitant cholecystectomy with AAA repair if gallstones found?

No
weight of opinion has shifted away from synchronous cholecystectomy.

97

concomitant resection of Solid tumors of the spleen, liver, and adrenal gland the time of AAA repair

appears reasonable
as long as patient can tolerate

Giventhe typically sterile nature of these organs,

98

Current data support open aneurysm repair at a threshold size of

5.5 cm in men and 5.0 cm in women.

99

recent travel, abdominal pain, fever, vomiting heterogenous cyst right lobe calcified - diagnosis and treatment

HYDATID cyst
echinococcosis

albendazole or mebendazole - preop is reasonable but his therapy alone 50% disappearance

select groups of patients who cannot tolerate a major procedure or the cyst appears small and heavily calcified. Percutaneous aspiration is not recommended due to the risk of anaphylaxis.

100

Lachman test

The knee is flexed at 30 degrees
Examiner pulls on the tibia to assess the amount of anterior motion of the tibia in comparison to the femur

101

where the majority of protein digestion and absorption occur

jejunum 80-90%

102

what tissue layer is chronic body tumor found in

posterior medial adventitia

nerve crest-ectodermal

paraganglia extra-adrenal

103

most common presentation of carotid body tumor

typically are asymptomatic

can present with neck pain, dysphonia, hoarseness, stridor, dysphagia, or sore throat. In rare occasions these tumors can present with extraadrenal like symptoms such as palpitations, tachycardia, and hypertension.

104

tumor associated with Pancoast tumor, symptoms and treatment

SQUAMOUS cell lung cancer

neural INVASION

ulnar nerve distribution, infected

sympathetic chain-Horner syndrome

first line treatment:
radiation

RARE tumor is amenable to surgery require en bloc rib resections

105

most common cause of pyogenic liver abscess

biliary obstruction:
Strong, stricture
Iatrogenic, stent

106

was common site of pyogenic liver abscess

RIGHT - preferential blood flow to right side

107

was common pathogens of pyogenic liver abscess

Escherichia coli
Klebsiella

108

LFTs and pyogenic versus amoebic abscess of the liver

pyogenic LFTs elevated more commonly

109

Hunter's canal structures in the canal and boundaries

also called adductor canal

superficial femoral artery and vein
saphenous nerve

Vastus medialis
Careful, this is the anterior and lateral border

Abductor magnus and longus-posterior border

Sartorius-roof and medial border

110

which is more important prognosticator for malignant melanoma thickness or nodes

nodes

other prognosticators:
Thickness
Mitotic rate
Ulceration
LDH

111

factor associated with platelet aggregation and vasoconstriction in wound healing

Thromboxane A2

112

most common type non-small cell lung cancer

squamous cell
Large cell
Adenocarcinoma

113

stage of lung cancer positive ipsilateral mediastinal node

into

Stage IIIa

114

stage of lung cancer T4 lesion

stage III regardless of nodal status

115

with the exception to metastatic guideline for lung cancer with resection surgery as treatment

Rarely, isolated metastases can be resected from the:
Brain!
Adrenal gland!

116

anterior cord syndrome

loss of
motor
pain and temperature

maintained
proprioception
find touch

117

Brown-Séquard syndrome

Hemisection injury to cord

ipsilateral motor and proprioception

contralateral pain and temperature

118

central cord syndrome

usually cervical

Upper extremity motor loss

Lower extremity with some preservation

Sacral sensory spared

119

cauda equina syndrome

lumbosacral nerve roots

The reflected bowel or bladder

Variable motor and sensory loss to the lower limbs

120

posterior cord syndrome

loss of proprioception vibration only

121

Collateral and branch contributions to the anterior spinal cord perfusion

Adamkiewicz

anterior spinal, intercostal, and lumbar arteries