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Flashcards in MIX 8 QBANK Deck (246):
1

GB adverse effect of ceftriaxone

can cause GB SLUDGE

2

course of cystic artery compared to common hepatic duct

POSTERIOR

3

cystic artery variations

GDA
SMA
COMMON hepatic artery

Usually comes off RIGHT hepatic

4

primary source of bilirubin in the body

Senescent red blood cells

Whether due to aged cells or active hemolysis, hemoglobin is broken down into bilirubin and ultimately secreted into bile.

5

incidence of TIPS shunt stenosis

(up to 50%)

6

TIPS is what kind of shunt

side-to-side portosystemic shunt

nonselective shunt and completely diverts portal flow

TIPS is also effective in the treatment of medically intractable ascites

7

major cause of TIPS Shunt stenosis

neointimal hyperplasia

8

treatment of TIPS Shunt stenosis

often be resolved by balloon dilation

in some cases, by placement of a second shunt.

9

frequency of post-TIPS encephalopathy

(∼30%)

10

effectiveness of TIPS compared to endscopic tx of bleeding

TIPS more effective

11

effect of TIPS on pts requireing liver transplant

HELP temporize them!

does not mess with vasculature

12

risk factors associated with melanoma

UVA and UVB radiation
congenital nevi,
dysplastic nevi,
xeroderma pigmentosa,
family history

NOT actinic keratoses
(careful, actinic keratoses IS risk for squamous)

13

tx of Immediate sensory and motor deficits after creation of an arteriovenous fistula

requires immediate ligation

NOT DRIL

The DRIL (distal revascularization - interval ligation) procedure is used in patients that do not have dramatic symptoms in the immediate postoperative period

14

treatment of symptomatic Meckel's diverticulum

Uncomplicated:
Diverticulectomy only

complicated:
Diverticulitis, GI bleeding, wide-based-
segmental resection

wait for obstructive symptoms to resolve?

15

Diagnosis of Zenker's diverticulum

barium swallow

16

incision for opened Zenker's diverticulum

left neck

17

when is a myotomy alone sufficient for Zenker's

diverticulum less than 2 cm

18

when is diverticulo pexy performed for Zenker's

elderly patients
LARGE diverticula to avoid complications of resection

19

prophylactic pre-incision antibiotics for colon surgery

second generation cephalosporin
cefoxitin
Cefotetan

or

Cefazolin and Flagyl

20

winded a therapeutic course of antibiotics recommended instead of just prophylactic pre-incision antibiotics for trauma

greater than 6 hours and time of injury

Signs of infection intraoperatively

21

symptoms of hypoglossal nerve injury

IPSILATERAL (towards the site of injury)
Tongue deviation

22

marginal mandibular nerve

branch of the facial nerve
“motor car”
Retraction and angle of mandible
Drooping of ipsilateral lip

23

site of injury from deceleration trauma of aorta

ligamentum arteriosum

just distal to subclavian

24

A 26-year-old female with a 3 cm heterogeneously enhancing hepatic lesion

adenoma

less than 4 cm and is asymptomatic, it does not need to be resected. If the patient is taking oral contraceptive pills (OCP), she should be advised to discontinue them.

25

margin for hepatic colorectal cancer metastasis

1 cm

Surgery give the best chance for cure

26

5 cm peripheral and centripetal enhancing hepatic lesion on CT

Cavernous hemangioma

does not need resection unless symptomatic

27

A 36-year-old female with a left hepatic liver lesion that has a central stellate scar

focal nodular hyperplasia

No malignant potential

Does not need resection unless symptomatic or cannot be definitively differentiated from cancer

28

Treatment of hepatocellular carcinoma with involvement of the portal vein

no surgery

29

proper location to administer an ilioinguinal nerve block?

1 cm medial and 1 cm inferior to the anterior superior iliac spine

30

when does carcinoid syndrome develop

small bowel ( ileum) - large portion of the liver must be replaced with carcinoid tumor for symptoms

careful, not with rectal

31

what our exceptions or carcinoid tumors develop more commonly with rare primary locations

organs the bypass hepatic circulation:
Ovary
Testes
Lung

these produce carcinoid syndrome without hepatic metastases

32

signs of air embolus

cardiovascular collapse,
dysrrhythmias,
characteristic “Mill wheel” murmur.

pulmonary artery hypertension,
elevated central venous pressure,
jugular venous distension.

33

most common cause of dialysis unit is now having difficulty using the fistula long term

outflow stenosis - typically intimal hyperplasia

occurs anywhere in the vein of an AV fistula
or
at the anastomosis of an AV graft

34

most common type of melanoma

superficial spreading
initial growth a radial-been potential for vertical


Careful, the prognosis is lentigo melanoma

35

most common melanoma an elderly

lentigo melanoma

best prognosis

36

type of melanoma with worse overall prognosis

nodular–vertical growth phase

37

when do type II pneumothorax began to develop

24 weeks
Careful, there is not adequate surfactant until 35 weeks

Continue develop after birth

38

which is more common type I or type II pneumocytes sites

type II

careful, lower surface area and a type II than type I
however, type I cover 95% of alveolar surface

39

enzyme that activate trypsinogen and where it is found

enterococci

Duodenum

40

enzymes that are secreted from the pancreas in active form

lipase
Amylase
ribonuclease

41

mechanism of trypsin and chemotrypsin

protein breakdown

42

extracolonic manifestations that will improve after colectomy for ulcerative colitis

erythema nodosum
Arthritis
Ankylosing spondylitis
Pyoderma gangrenosum

NOT PSC

43

treatment for primary sclerosing cholangitis

liver transplant

44

percentage of splenic artery aneurysms that present with year-old bleed; and percent mortality with rupture

20-30% present with abdominal pain and contained rupture and lesser sac - free rupture within 48 hours

( 20-50% rupture risk)

25% mortality with rupture

80-90% maternal and fetal mortality with rupture

45

treatment of splenic artery aneurysm

ligation or embolization of both the proximal and distal aspects of the aneurysm

46

most common side effects with pancuronium

tachycardia

coronary artery disease relative contraindication

47

side effects of succinylcholine

hyperkalemia with:
Spinal cord injury
Burn
Rhabdo - including prolonged immobilization
renal disease
Others:
Malignant hyperthermia
Rhabdomyolysis
Ocular hypertension
Muscle pain

used for rapid sequence intubation

48

clearance of vecuronium

BOTH liver and kidney

49

with organ dysfunction is Atracurium good for and what is a side effect

minimal cardiac fracture

histamine release - vasodilated

50

pathophysiology of developing ascites from cirrhosis

fibrotic and parasites lead to portal hypertension

Lymphatic bed of liver and splenic neck lymph nodes began to leak into the peritoneum

This includes protein losses-hence the reason for albumin administration

51

mechanism of elimination of succinylcholine

pseudocholinesterase

only depolarizing agent

rapid onset and short half-life

Patient's may be deficient in pseudocholinesterase - prolonged half-life

52

best prophylaxis for contrast-induced nephropathy

fluid hydration

no significant benefits of:
Mucomyst
Bicarbonate
Dopamine

With hold:
Loop diuretic
ACE inhibitor
Angiotensin II antagonists

53

Risk factors for contrast-induced nephropathy

multiple myeloma
Proteinuria
Diabetes mellitus
Dehydration
concomitant other nephrotoxic drugs
Renal failure

54

what part of the kidney does contrast injure

renal tubule

Transient regional ischemia

55

acute cholangitis bacteria

Escherichia coli
Klebsiella

Others:
Bacteroides stridulous
Streptococcus faecalis

56

the tissue named vessels branches of the external iliac artery

deep circumflex iliac:
collateralizes with lateral femoral circumflex artery to the superior iliac spine also supplies collaterals to lower leg

Inferior epigastric (careful, pelvis and abdomen origin) - this vessel anastomosis with superior epigastric artery which is a branch of the internal thoracic

57

management of splenic abscess

IV antibiotics splenectomy-particularly of multiloculated and complex

possible IV antibiotics and CT-guided drainage-however, risky for bleeding only considered with unilocular simple abscess

58

time frame of intimal hyperplasia seen for graft stenosis

within 2 years of surgery


59

Cells involved with intimal hyperplasia

Spindle cells

60

Treatment of intimal hyperplasia and graft

Most effective after 6 months
balloon angioplasty using cutting balloon

early within 3 months:
Patch angioplasty
or
vein graft

61

what timeframe does atherosclerosis of graft usually occur

after 2 years

62

most common location of indirect inguinal hernia sac compared to cord structures and cremasteric muscle

deep to cremaster

Anterior and superior to spermatic cord -
hernia sac is carefully Divided off of cord structures

63

when can sigmoid ischemia be watched after triple-A repair regarding endoscopic findings

ischemia limited to the mucosa
Adequate perfusion
Antibiotics and bowel rest

64

physical symptoms of myasthenia gravis

ptosis
Diplopia
Weakness with repetitive movements
Fatigue

65

Percentage of myasthenia gravis patient who will have associated thymoma

only 10%!
thymectomy anyway

66

Percentage of patients with thymoma who will have myasthenia gravis

50%

67

percentage of improvement and myasthenia gravis after thymectomy

80%?

68

Pathway of conversion synthesis of catecholamine and adrenal medulla

Tyrosine - all starts with going in the ring
L. dopamine - the dop
Dopamine - gets dop
Norepinephrine - starts getting adrenl
Epinephrine - gets adren

69

only site of epinephrine production

adrenal medulla

converting norepinephrine to epinephrine

enzyme:
PNMT - final step path

70

steps and reducing the phimosis and possible complication

dilated with surgical clamp
Dorsal slit circumcision by urologist to temporize

paraphimosis - prepuce is trapped behind the glans-this is a urologic emergency - arterial flow continues without any risk or lymphatic congestion

71

treatment of paraphimosis

neurologic emergency

Emergent reduction required of pharphimosis in all circumstances

72

algorithm for hematochezia

NG lavage rule out upper GI

NG lavage negative colon
Bleeding intermittent and stable-colonoscopy

Brisk bleeding:
Colonoscopy not helpful can't see anything

Localization study:
Angiography-diagnostic and potentially therapeutic-requires bleeding rate of at least 0.5 mL per minute

73

Pathway of oxalate kidney stones and Crohn's

normally:
Oxalate is bound into calcium oxalate and the bound form is excreted in the stool

With Crohn's:
steatorrhea and problems absorbing fat
the fat competes to bind calcium (leaving the oxalate free)

unbound oxalate reabsorbed by the colon and excreted by the kidney






74

treatment oxylate stone forming

calcium citrate

exatra calcium precipitates dietary oxalate

and citrate prevent stone formation and urine

75

syndrome of complete loss of adrenal function and potential cause

Waterhouse-Friderichsen syndrome is an adrenal gland hemorrhage that occurs after meningococcal sepsis infection

also described with pregnancy

76

lab findings with adrenal insufficiency

hyponatremia - lost aldo
HYPER kalemia -
Hypotension
fever

sometimes hypoglycemia - cortisol def

77

Gram negative bacteria cause of sepsis

ENDOtoxin

Lipid A
(within lipopolysaccharide component)

78

hemangioma CT finding

Peripheral enhancement

79

treatment of hemangioma

increased size
Symptoms
Kasabach-Merritt syndrome.- Consumptive heart failure

enucleation first choice

May require segment segmentectomy

NOT embolization

80

pressure the diagnosis portal hypertension

greater than 5

careful compared to IVC normal 0-5

81

portal pressure associated with esophageal variceal bleeding

–12

82

how is portal pressure calculated

difference between IVC and portal vein

83

best test to measure portal pressure and sinusoidal disease

e.g. cirrhotic
hepatic wedge

84

best test to measure portal pressure and pre-sinusoidal disease

EG schistosomiasis


wedge is not good-falsely low measurement

85

exam finding that differentiated AV fistula from pseudoaneurysm

thrill in CHF fistula

86

findings with popliteal entrapment

palpable pulses

Claudication with provocative activity

We progressed the paresthesias



87

Anatomic etiology of popliteal entrapment

develops in utero!

MEDIAL head of the gastroc
Or developmental problem popliteal artery


88

40-year-old smoking female string of beads on CTA left internal carotid

fibromuscular dysplasia of the carotid artery

89

symptoms of fibromuscular dysplasia of the carotid artery

TIA
Stroke
Disability

90

diagnosis of fibromuscular dysplasia of the carotid artery

ultrasound and CTA

possible angiogram

string of beads

91

treatment of fibromuscular dysplasia of the carotid artery

asymptomatic :
Antiplatelet therapy

Symptomatic:
Open - surgical dilation
or
angioplasty - gaining acceptance

NOT stent-redundancy kink, coil not amenable to this

92

most important muscles involved an active expiration

rectus
Internal oblique
The external oblique
Transversus abdominis
Internal intercostal - pull the rib cage down
external intercostal

93

femoral hernia tissue repair

McVay (Cooper's repair) approximate transversus abdominis aponeurosis to Cooper's ligament

approach:
Incision ABOVE inguinal ligament
The external oblique aponeurosis split From external ring to internal ring-preserve ilioinguinal nerve

Open transversalis fascia
Hernia sac medial to the inferior epigastric vessels
Hernia sac freed from inguinal ligament

Medial:
Sutures placed pubic tubercle through transversus abdominis to Cooper's ligament below

lateral:
Transition suture close femoral canal

Relaxing incision:
Anterior rectus sheath


94

treatment of fat emboli

immediate stabilization of fracture or long bones Decreases incident

supportive management:
May require intubation


Not proven:
Steroid in heparin

95

treatment of mesenteric obstruction and FAP patient with history of total domino proctocolectomy and ileoanal anastomosis

sulindac - anti-inflammatory medication decrease the size of desmoid tumor

96

LaPlace equation

tension = pressure x (radius / wall thickness)

97

2-year-old boy watery diarrhea, palpable mass on his right flank. elevated blood pressure and metanephrines in his urine. ataxia

nephroblastoma!

The

98

poor prognosticators of nephroblastoma

age or than one
Increasing neuron specific enolase
LDH
N-myc amplification

99

Findings that gives nephroblastoma better prognosis

hyperdilipoid
more DNA within tumor

more susceptible to chemotherapy

100

palliation of unresectable pancreatic cancer

at endoscopic or PERCUTANEOUS transhepatic stent

Endoscopic BETTER results of your complications

Percutaneous reserved for patients with technical issues with endoscopy

metal stent longer lasting

Gastric outlet obstruction-second portion of duodenum

Duodenal obstruction-third or fourth portion and duodenum

Biliary obstruction:
Endoscopic expandable metal stent and duodenum

Not able to stent-gastro J.

pain refractory to narcotics:
Endoscopic or percutaneous celiac plexus block

101

most common scenario her surgery is the approach taken to palliate pancreas cancer

undergoing laparotomy for anticipated resection and found to be unresectable

102

most accurate diagnosis for renovascular hypertension

angiography!

Ultrasound is screening tool to assess flow velocities

MRI made over diagnosis

103

indications for surgery of spontaneous pneumothorax

recurrence
Persistent leak
Incomplete expansion
High risk-high-pressure environment including air travel

104

Berger disease

small and medium vessels

Tobacco worsens

Usual involves more than one digit

Initial treatment tobacco cessation

105

ABI calculation and findings

ankle divided by brachial

higher of the 2 sides used

Dorsalis pedis and posterior tibial

Normal 1.0
claudication 0.7-0.9
Rest pain 0.4-0.7
Wound complications and gangrene/tissue lost LESS than 0.4

106

cholangiocarcinoma risk factors, major prognosticator

primary sclerosing cholangitis

margin status

107

treatment of cholangiocarcinoma

surgery only chance for cure

NO chemotherapy



108

classification of cholangiocarcinoma

#1 involves common hepatic duct
#2 hepatic bifurcation
#3 secondary hepatic ducts on one side
#4 tumors involved both side secondary hepatic ducts

109

medial pectoral nerve

supply of both pectoralis major and pectoralis minor

110

lateral pectoral nerve

supplies only pectoralis major

pectoralis major more lateral

111

where anatomically does Zenker's diverticulum develop

posteriorly
Transition zone between hypopharynx and esophagus-scalene triangle
Weakness near the cricopharyngeus muscle because from failure relaxation of upper esophageal sphincter

FALSE diverticulum

112

shortness of breath and dyspnea on exertion. A chest x-ray shows a small calcified lesion in the right upper lobe that is new from previous films. The patient reports that he was recently on a hiking trip in Ohio

histoplasmosis

113

treatment histoplasmosis

self limiting and do not require any further intervention!

careful, observe but These patients can have bulky mediastinal nodes that can cause compressive symptoms.

114

course of the thoracic duct

originates at the cysterna chyli at L1-L2
courses superiorly on the RIGHT the AORTIC hiatus.
right of midline until
CROSSES to the left at T4-T5.
empties in to the LEFT subclavian vein at the junction with the IJV

careful, not brachiocephalic

115

surveillance Peutz-Jegher syndrome

colonoscopy every 2 years

extracolonic cancers screening should begin at age 25

cervical and breast screening

other extracolonic cancers:
Thyroid
Lung

116

timing of surgery for congenital diaphragmatic hernia

not emergent

Plan for date 2-3 of life the neonate is free of significant respiratory and cardiovascular compromise

117

treatment of duodenal adenocarcinoma first or second portion of duodenum

Whipple resection

no chemoradiation

118

Treatment of duodenal adenocarcinoma third or fourth portion of duodenum

segmental resection

no chemoradiation

119

unstable patient esophageal perforation found to have cancer

cervical esophagostomy
gastrostomy
feeding J.

120

Gold standard for AV fistula access

radiocephalic wrist-Cimino

anatomic snuffbox or just above the wrist crease

121

that study to workup colovesicular fistula

CT scan
and demonstrate pneumaturia

but also needs colon
Endoscopy
Cystoscopy

122

blood supply to the pancreas

celiac
Superior mesenteric artery
Splenic artery


123

when is carotid endarterectomy not indicated

less than 50% stenosis

124

indications for carotid endarterectomy

greater than 60% stenosis even asymptomatic

125

size of ileal resection consistent with vitamin B12 problem

60 cm

126

size ileal resection at risk for bile acid malabsorption

100 cm

liver cannot compensate with increased hepatic symphysis the bile-fat is not bound with bile sufficiently causing steatorrhea

127

algorithm for workup of hemobilia

stable:
Endoscopy rule out other causes of upper GI bleed

Unstable high index of suspicion:
Angiography therapeutic and diagnostic

128

Prior to dividing the gastrohepatic ligament at the right crus, what aberrant structure may be encountered

and accessory LEFT hepatic artery originating from the left gastric artery

careful, right crus region may have a LEFT accessory hepatic artery

129

structures to be where of dissection around the right crus

LEFT vagus anterior
L APR
careful, right crus left anterior vagus

LEFT accessory hepatic artery and

130

pyoderma gangrenosum

treatment steroids

Improved with resection of inflamed bile

Associated with inflammatory bowel disease

131

and primary bile salts are conjugated where and by what

hepatocytes

GLYCINE

Taurine

132

most common bacteria the colon

Bacteroides fragilis

Other anaerobes:
lactobacillus bifidus
clostridium
Eubacterium

Aerobe:
Escherichia coli- most common AEROBE
Klebsiella
Proteus
Enterobacter
enterococcus-Streptococcus faecalis
careful,

133

what helps platelet behind the endothelium

von Willebrand factor

134

What helps platelet aggregate

thromboxane A2

other affect is vasoconstriction

135

what cross-links platelets

thrombin

converting fibrinogen to fibrin

interval, cross-linking is not aggregation

136

major inflammation stimulator for atherosclerosis

lipid core made from LDL

137

at what point is compensatory arterial dilation no longer sufficient to compensate for percentage of stenosis from plaque

40%

careful, exertional angina not seen total 75% stenosis

138

the role of Nissen fundoplication with Barrett's esophagus

better than trying to maximize medical therapy

because there is continuation of reflux even if acid is controlled

139

relationship of aortic arch and a thoracic duct

thoracic duct runs posterior to the arch

Originates at the cisterna chyli between T10 and L3 and enters the chest through the aortic hiatus to the right of the aorta and at T5, turns left and courses posterior to the aortic arch

courses anterior to the vertebral bodies between the aorta and the azygos vein and posterior to the esophagus

140

mechanism of Cilostazol

Pletal

This is a phosphodiesterase III inhibitor
works on cAMP

Acts to:
inhibit smooth muscle so contraction and platelet aggregation

141

mechanism of action of Pentoxyfiline

increases blood cell look stability

mechanism unknown

used to treat claudication on

142

mechanism action of statin

HMG CoA reductase inhibitor

143

drugs that inhibit cyclooxygnease

ASA
nonsteroidal anti-inflammatories

144

mechanism of action of Plavix

irreversibly inhibited

adenosine diphosphate ADP
on platelet cell membrane

145

only FDA approved treatment for claudication by medication

Cilostazol phosphodiesterase 3 inhibitor - decrease smooth muscle/decreased platelet aggregation

Pentoxyfinline - red blood cell flexibility

146

findings of esophageal scleroderma

low amplitude
Simultaneous contractions
Normal lower esophageal pressure

careful, achalasia can have simultaneous contractions-difference is fail relaxation the lower esophageal sphincter

147

treatment of esophageal scleroderma

treat underlying scleroderma and secondary symptoms of esophagus improve

methotrexate and immune modulaters

148

diagnoses test of choice for blunt aortic dissection

TPA

149

aortic Aneurysm of Marfan syndrome

aortic root!

risk of dissection

150

defect in Ehlers-Danlos syndrome

collagen

151

treatment of immediate postop intracranial embolism after carotid endarterectomy

thrombolytics

152

inspiratory reserve volume

At the end of tidal volume inspiration

it is the maximum volume that can be inhaled from there

153

expiratory reserve volume

from the end of title volume exhalation

the maximum amount of air that can be exhailed from there

154

residual volume

volume air remaining in lungs after maximal exhalation
this includes a dead space

155

total lung capacity

volume in lungs after maximal inflation

156

inspiratory capacity

inspiratory reserve volume
AND tidal volume

157

functional residual capacity - definition and calculation

the volume in lungs after normal exhalation

total lung capacity minus inspiratory capacity

or

expiratory reserve volume PLUS residual volume

158

vital capacity

total lung capacity minus residual volume

159

structures of the anterior compartment of the leg

extensor pollicis longus
Extensor digitorum longus
Tibialis anterior
Peroneal tertius

deep peroneal nerve
( careful, deep peroneal nerve not so deep - anterior compartment does not have tibial nerve)

ANTERIOR tibial artery

160

nerve most commonly injured during lower extremity fasciotomy

superficial peroneal nerve

Superficial is at risk with - lateral incision - lies near the septum

located in the lateral compartment

161

described for compartment fasciotomy

medial and posterior incision to the tibia:
decompresses superficial and deep posterior

lateral incision:
Intermuscular septum
decompresses anterior and lateral compartments

162

defect with injury to superficial peroneal nerve

inability to evert foot

most commonly injured nerve during fasciotomy-lateral compartment

163

defect was injury deep peroneal ulnar

FOOT DROP

unusual to injure during fasciotomy

164

location of the deep peroneal nerve

ANTERIOR compartment

most commonly compressed nerve and compartment syndrome

165

location and defect with tibial nerve

DEEP POSTERIOR compartment

166

nerve and vessel and deep posterior compartment

tibial nerve

Posterior tibial artery

(careful, deep peroneal nerve is ANTERIOR compartment)

167

most common organism for prosthetic graft infection

staph aureus

( careful, no specific infection is staph epidermidis)

168

relationship of right hepatic artery to the common hepatic duct

right hepatic artery passes posterior to common hepatic duct as it heads towards the liver 85% of the time

169

relationship of right replaced hepatic artery

to portal triad and

medial aspect of Calot's triangle

POSTERIOR to CYSTIC duct

170

first location of metastasis in the invasive gallbladder cancer

or cystic duct lymph nodes

171

largest resistance and drop in blood pressure change of any vessel

arteriols

careful, not capillaries that are downstream - because surface area is so large and extensive network branching

172

hereditary non-polyposis colon cancer special tumor characteristics

microsatellite instability
MLH1 MSH2 genes - these cause the:
DNA mismatch repair

173

Amsterdam criteria

3 or more first degree relatives colon cancer

Across 2 generations
One member diagnosed prior to the age of 50

174

associated with Lynch I

colon cancer

175

associated with Lynch II

Cancer of :

endometrial
Ovarian
Gastric

176

origin of the internal thoracic artery

first branch off subclavian

177

tissue supplied by internal thoracic artery

chest wall
Breast
Branches to
Thymus
Mediastinum
The sternum

178

course of the internal thoracic artery

first branch off subclavian

Between the internal oblique and transverse thoracic muscles

Bifurcated sixth intercostal space

Muscular phrenic

Superior epigastric artery explanation mark

179

cranial nerve innervated carotid body

cranial nerve 9

Branch of glossopharyngeal

180

physiologic mechanism and responsive carotid body

edema receptor

Paraganglioma

Stimulated by:
Hypercapnia
Hypoxia
Decrease pH
Increase temperature
Signs none
Nicotine

action:
Sympathetic stimulation
Increased heart rate
Increased vascular tone
Intracerebral cortical activity

181

what do hepatocytes produced

bile
Synthesis proteins
Synthesis glucose

182

Space of Disse

interaction between hepatocyte and blood

substances are exchanged via active transport

183

recommended treatment for posterior knee dislocation and no flow past proximal popliteal artery on angiogram

bypass with CONTRALATERAL reverse saphenous vein

184

the gallbladder his mechanism of bile concentration

ATPase dependent sodium chloride transport

185

treatment of 2 cm common iliac occlusion

angioplasty and stent procedure of choice for all common iliac stenoses
less than 3 cm

186

most common time period to develop aorto enteric fistula

2-6 years

187

diagnostic modality that best demonstrates chance of cure and squamous cell carcinoma of the esophagus

EUS

EUS is better than PET

188

most important prognosticators for esophageal cancer

depth of tumor penetration and node involvement

189

indications on EUS the esophageal cancer his resectable

not invaded adjacent organs

Fewer than 5 enlarged lymph nodes

190

when should screening begin with HNPCC

colonoscopy age 20 and all polyps removed

191

recommend surgery for HNPCC colon cancer

total bowel colectomy with ileorectal anastomosis

or

female in no longer childbearing:
total abdominal hysterectomy and salpinco-oophorectomy

careful, FAP surgery is total abdominal proctocolectomy with ileal anal J-pouch

192

extent of colon resection for cancer proximal to the hepatic flexure

right hemicolectomy:

Resect ileum approximately 5 cm proximal to the ileocecal valve

anastomosis to the first third of the transverse colon

take the right branch of the middle colic artery

also takes:
Ileocolic
Right colic

193

mechanism action of pancreatic polypeptide

suppress:
bile secretion
gallbladder contraction
exocrine pancreatic function

194

treatment of superior vena cava syndrome from multiple tunneled hemodialysis catheters

balloon angioplasty - first choice
( NOT embolectomy thrombectomy)

Often requires multiple interventions

Stents for now been tried - with some success

195

percentage of gallstone ileus as the cause in an obstruction in patient older than 70 With no previous surgery and no hernias on exam

up to 25%!

196

most common site of fistula and most common site of obstruction from gallstone ileus

duodenum

terminal ileum-most narrow

197

epiphrenic diverticulum

pulsion diverticulum

distal esophagus

does not contain all layers of esophageal wall

198

traction diverticulum

all layers of esophageal wall

midesophagus

199

post thrombotic syndrome

23-60% of deep venous thrombosis

edema
Pigmentation
Calf muscle dysfunction
Venous stasis ulcer
Valvular incompetence
Chronic venous insufficiency

200

fibromuscular dysplasia pathophysiology and most common site of recurrence

most common site renal artery 80%

females 40-50-year-old

Medium-size arteries

MEDIAL most common

other less common sites:
Carotid artery
Iliac artery
Vertebral artery

201

primary treatment of sliding hernia

type I hernia

PPI

202

List order of prevalent of hiatal hernia

type I #1 most common
careful, type III SECOND most common
type II third most common

203

structures at risk when dissecting posterior hiatal hernia sac in the mediastinum

left anterior vagus nerve
pleura, esophagus, and inferior pulmonary veins

204

treatment of acute cholecystitis in patients who are too high a risk to undergo surgery including child's C.

transit hepatic cholecystostomy

even in child C.

205

where is the swallowing Center located

Medulla

same as breathing center

206

risk of major limb amputation in patient with intermittent claudication per year

1% per year

207

Severity of stenosis is categorized according duplex ultrasound



Less than 20% stenosis (NORMAL):

-Velocities: 150 cm/sec
-Waveform Characteristics: Spectral broadening throughout systole with no change in waveform
-Management: Rescan in 6 months

50% to 75% stenosis (MODERATE):

-Velocities: >180 cm/sec
-Waveform Characteristics: severe spectral broadening in systole with reversed-flow components
-Management: Rescan in 4-6 weeks; if lesion does not progress during two cycles of testing, increase scan interval to 3 months

Greater than 75% stenosis (SEVERE):

-Velocities: >300 cm/sec
-Waveform Characteristics: severe lumen reduction with a "flow jet"; damped distal velocity waveform
-Management: Recommend repair (urgent if average PSV 0.15)

208

primary functional bile acids

digestion of fat

209

where are bile acid conjugated

hepatocyte:
Glycine
Taurine

Colon:
Bacteria conjugate primary bile acid into:
deoxycholic acid
lithocolic acid


210

enzyme responsible conjugate primary bile acid

Glucoronyl transferase

211

non gallstone reasons to perform cholecystectomy

hydrops - Cystic duct obstruction
Biliary dyskinesia
porcelain gallbladder ( but less concerned than patch were calcification)

NOT ascending cholangitis

212

when do you start upper scope screening patients with FAP

age 20-25
OR
When colonic polyps first appear

213

76-year-old female presents on post operative day #14 from a left femoral-popliteal bypass graft with PTFE with acute left lower extremity pain. You suspect that the graft has thrombosed.

Which is the MOST appropriate treatment for this patient?

Thrombectomy

with intra operative angiogram

214

RCC that extends into the IVC

can be pulled out during the radical nephrectomy.

215

AAA renal dysfunction perioperatively increased in

26-42% incidence

supraceliac clamping
Increased age
preoperative hypotension
prolonged clamp time

216

described anatomy of right renal artery

medially below SMA L2
longer than the left as it courses POSTERIOR to inferior vena cava
posterior to renal vein
25-30% have accessory renal arteries

217

surgical exposure required to access right renal artery

Kocher maneuver
Take down the right colon

218

pigmentation pigmentation of bile

bilirubin diglucuronate
conjugated form

219

primary source of bilirubin

senescent red blood cells
breakdown of heme
heme is converted to:
biliverdin
biliverdin is converted to:
bilirubin
bilirubin is taken up by hepatocyte:
conjugated by glucuronic acid


220

what gave his stool bile color

URObilinogen

this is because he did bilirubin from bacteria - and the amount not reabsorbed is passed in the stool

221

effect of nitric oxide on platelet irrigation

INHIBITS aggregation

careful, vasodilation major factor

in also:
Decreases inflammatory response
decreases:
VACAM - 1
ICAM - 1
MCP - 1


222

list the order of splenic aneurysms

splenic 60%
hepatic 20%
SMA 5.5%
celiac 4%

223

treatment of pseudoaneurysm common femoral artery

greater than 2 cm:
Thrombin injection

open repair:
greater than 5 cm with wide neck
Overlying skin necrosis
distal ischemia
Nerve compression
active bleeding

224

most common postoperative swelling of lower extremity bypass for chronic ischemia

lymphedema

generally improves over 2-4 months

225

most common bacteria to cause lymphangitis and upper extremity

Streptococcus pyogenes

careful, other cause:
Staph aureus

226

treatment of the iliac and femoral DVT in patient with swelling and extreme pain

thrombolysis - catheter directed



227

superior mesenteric artery syndrome treatment


chronic:
duodenojejunostomy

not arterial bypass

Less common surgical treatments for SMA syndrome include Roux-en-Y duodenojejunostomy, gastrojejunostomy, anterior transposition of the third portion of the duodenum, intestinal derotation, and division of the ligament of Treitz.

acute:
Medical management
Pro-motility agents such as metoclopramide may also be beneficial

228

etiology of superior mesenteric artery syndrome

compression of the third portion of duodenum between superior mesenteric artery and perivertebral musculature/vertebrae

If conservative treatment fails when reversed peristalsis persists,

229

Factors that decrease the risk of PAD

HDL,
nitrous oxide
prostacyclins

230

What is the MOST likely organism to be associated with a non-aneurysmal aortic infection

Salmonella

careful, STAPH is most common when associated with aneurysm

careful, STREP is most common when infection is to do bacterial endocarditis

231

Most likely location for non-aneurysmal aortic infection

suprarenal

232

postoperative intervention that had the most influence on vein graft patency

duplex ultrasound- improved patency by 15% when compared to clinical examination

Careful, Plavix is used not definitively proven for end result patency

233

treatment of phlegmasia cerulea dolens

catheter directed thrombolytic can improve her outcome

The alternative for this condition is surgical venous thrombectomy.

No matter which treatment is chosen, long-term anticoagulation is indicated.

Careful, thrombectomy and systemic umbilicus have poor results

234

Presentation of phlegmasia cerulea dolens

complication and DVT-
arterial inflow can be compromised
Complete occlusion of the venous system
venous gangrene can develop unless flow is restored.
edema and blistering with cyanosis

occasionally involve the trunk colon

235

symptoms of vertebral artery stenosis

dizziness
Vertigo
Tendinitis
Dysphagia
Dysarthria
Ataxia

236

indications for treatment or vertebral artery stenosis

symptoms

237

lymphedema precox

primary lymphedema

Occurs after puberty

238

Lymphedema tarda

primary lymphedema

Recurred in women after the age of 35

239

relationship of nitric oxide to LDL

nitric oxide inhibitor of LDL

240

history of MI is what kind of perioperative risk

intermediate!

241

physical diagnosis of Steal syndrome AV fistula

compressed graft relieve symptoms and returns radial pulse

242

size of popliteal aneurysm requiring surgery

2.5 cm or greater - 30% symptoms in 3 years

ligate aneurysm as well the bypass

243

strong risk risk factor for AAA

smoking

other risk factors:
MMP - damage to media and elastin
hypertension-infrarenal
age - decreased the last and

244

Layer affected in AAA

tunica MEDIA


245

presentation of occlusion of superficial femoral artery

thigh is still vascularized due to patent
femoral profundus!

discoloration of the knee and distally

246

presentation of occlusion of the common femoral artery

cool lower extremity from 5 distally

May have waterhammer pulse or no pulse