Parameters used to calculate Ranson score 48 hours after admission - HCT decrease > ___ - BUN increase > ___ - Ca ___ - Fluid requirement > ___

- HCT decrease > 10 - BUN increase > 5 - Ca 4 - Fluid requirement > 6L

Practice Tests Flashcards by Nikia McFadden

Abdominal compartment syndrome is defined as sustained intra abdominal pressure > ___ mmHg a/w new organ dysfunction or failure

20 mm Hg. Pressure this high is an indication of continuous monitoring

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What is the treatment of type 3 choledochal cyst?

Trans-duodenal approach with either marsupialization or excision of the cyst

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What is the preferred imaging to diagnose carotid body tumor?

CTA

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What is treatment for wandering spleen?

Splenopexy. Splenectomy if spleen is infarcted

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Pre-albumin’s half life is ____, and is the most commonly used acute indicator of ______

2 days

nutritional status

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What is the hallmark electrolyte disturbance a/w refeeding syndrome?

Hypo-phosphatemia

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_____ is required by nitric oxide synthase

L-arginine

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Treatment for atypical ductal hyperplasia

excisional biopsy

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After two years, ____ is the driving force for late bypass failure

atherosclerosis

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____ is typically the reason for bypass graft failure between two months and two years

intimal hyperplasia

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Bypass graft failure within 30 days of surgery is typically due to _____

a technical complication

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____ - the most common primary cardiac tumor in adults

____ the most common primary cardiac tumor in children

Myxomas

Rhabdomyomas

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_____ is the treatment of choice for simple intersphincteric fistula in ano that do not involve the external anal sphincter

Fistulotomy

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____ is the treatment used for these type of fistulas

Fistulas transversing the external anal sphincter, to preserve continence

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Aggressive, high grade lymphoma of ____ cell origin is most common lymphoma in the AIDS patient

B cell lymphoma

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IgA (does/doesn’t) activate complement –> cell mediated opsonization

Does not activate compliment and does not enhance cell mediated opsonization

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The two most important prognostic indicators for esophageal cancer are:

depth of tumor penetration and nodal involvement

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Treatment for undifferentiated spindle cell tumor (malignant fibrous histiocytoma of bone)

neoadjuvant chemotherapy and excision with wide margins

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Overall, the _____ provides the best route for esophageal substitutes during esophageal replacement

posterior mediastinum

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Parameters used to calculate Ranson score 48 hours after admission

HCT decrease > ___
BUN increase > ___
Ca < ___
PaO2 < ___
Base deficit > ___
Fluid requirement > ___

HCT decrease > 10
BUN increase > 5
Ca < 8
PaO2 < 60
Base deficit > 4
Fluid requirement > 6L

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How is surgical reduction of intussusception performed?

it is reduced by squeezing the mass retrograde from distal to proximal. Also perform an appendectomy.

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Which compartment of the lower leg is most susceptible to compartment syndrome?

Anterior, lateral, superficial posterior, deep posterior

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Best treatment after a blunt trauma leads to a distal pancreatic parenchymal transection

Distal pancreatectomy

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Treatment - large mesenteric cyst

Resection of cyst, wedge of mesentery, associated intestine, with primary end to end anastomosis

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Treatment - small mesenteric cyst

laparoscopic excision without bowel resection

wait time until interval appendectomy

6-8 weeks

Treatment options- actinic keratosis

- cautery and destruction - cautery and curettage - cryotherapy (Actinic keratosis is a precursor to SCC)

What is the most common location of the sinoatrial node?

The junction of the right atrium and SVC

Newborn baby AXR - distended abdomen at birth, multiple dilated bowel loops of varying sizes, bubbly or ground glass appearance in RLQ, few air fluid levels. This is classic for _______

Meconium Ileus

Do gastric hyperplastic polyps have malignant potential?

No. Very common in the normal population. No increased risk of gastric cancer.

Treatment for DVT 2/2 upper extremity central venous line

Remove catheter Heparin therapy long term oral anticoagulants for 3-6 months

Differentiation between acute thrombosis and chronic venous obstruction. Recent thrombi are ____-echoic, whereas chronic obstruction are ____-echoic compared to surrounding tissue

Recent thrombi are non-echoic or hypo-echoic | Chronic thrombi are hyper-echoic

The histologic characteristics of ____ rejection include infiltration of lymphocytes, plasma cells, eosiniphils, and neutrophils

acute rejection

Lap or open chole p which leads to more benign bile duct strictures

lap chole

What is the best way to image a thoraco-abdominal aortic aneurysm

CTA

Which of the following is not a danger-associated molecular pattern (DAMP), the endogenous form of pathogen-associated molecular patterns (PAMPS), which represent danger signals - Soluble Toll-like receptor 2 - Uric Acid - high mobility group box 1 (HMGB1) - S100

Soluble toll like receptor 2

What muscles are encountered (3) from skin to thyroid as you perform the exposure for a thyroidectomy?

- Platsyma - Sterno-hyoid - Sterno-thyroid

What are the most common post op complications after ileostomy reversal (2)?

- Small bowel obstruction | - wound infection

What is the role of protease serine 1 (PRSS1)?

This is a protease inhibitor found in the pancreas. Prevents autodigestion. A PRSS1 genetic mutation is an important cause of familial recurrent pancreatitis

What percentage of patients have resolution of pseudotumor cerebri following bariatric surgery?

100%

What is the Baux score (burns)?

Age + TBSA% (2nd degree+) = mortality risk

Intra-aortic balloon pumps _____ (inflate/deflate) during diastole to increase myocardial perfusion in cardiogenic shock, to help push blood through the dilated coronary vessels.

inflate

In the middle of a laparoscopic procedure, possibly after rapid infusion of blood products, the anesthesiologist informs you of sudden bradycardia, a drop in BP not responding to IVF, a "mill-wheel" murmur, and inferior ST-segment changes on the monitor. What is the diagnosis?

Venous air embolism

Management - venous air embolism (4)

- release of the pneumo-peritoneum - place patient in steep Trendelenburg - place patient in left lateral decubitus position - insert central line to aspirate air from right atrium

67F has ovarian cancer that involves both ovaries but does not extend into pelvis or abdomen. What is her stage?

Stage I - can involve both ovaries

After creation of an AV fistula, hand pain and ischemia are most likely related to _____ phenomenon

Steal Compression of the access may result in relief of symptoms and return of radial pulse, which is diagnostic of access-induced steal syndrome

Where in the pancreas are insulinomas most commonly located?

Evenly distributed throughout the pancreas

Where in the pancreas are gastrinomas located?

Passero's triangle

Large intestinal flora ferment oligosaccharides, that (can/cannot) be digested, into _______. The latter is used as fuel for _____

- cannot be digested - short chain fatty acids - colonocytes

_____ Toxicity - tinnitus, numbness/tingling of the lips and mouth, slurred speech, confusion, seizures, widened PR interval, widened QRS, sinus tachycardia

lidocaine toxicity

Cardiac effects of lidocaine toxicity (3)

- widened PR interval - widened QRS - sinus tachycardia

Management of medullary thyroid cancer

total thyroidectomy with bilateral central neck dissection (level 6 lymph nodes). If there is evidence of metastasis to lateral neck lymph nodes, add lateral neck dissection to that side

Medullary thyroid cancer is associated with elevated levels of _____

calcitonin

Medullary thyroid cancer is associated with which hereditary syndromes?

MENIIA and MENIIB MENIIA - perform prophylactic total thyroidectomy before age 5 MENIIB - perform total thyroidectomy before age 1

The correct order that cells arrive to acute tissue injury (5)

1. platelets 2. neutrophils 3. macrophages 4. lymphocytes 5. fibroblasts

What happens to maternal blood pressure during the first two trimesters?

It diminishes, due to a decrease in systemic vascular resistance

Which transplant drug has this method of action? Inhibits de novo purine synthesis, which inhibits growth of T cells

Mycophenolate (MMF, CellCept)

Which transplant drug has this method of action? Inhibits inflammatory cells (macrophages) and genes for cytokine synthesis (IL-2 most important

steroids - prednisone, solu-medrol

Which transplant drug has this method of action? Binds cyclophilin protein; CSA-cyclophilin complex, which results in decreased cytokine synthesis

Cyclosporin (CSA)

Which transplant drug has this method of action? Binds FK-binding protein, inhibits calcineurin, thus inhibiting T cell signal transduction and IL-2 production

Tacrolimus

Which transplant drug has this method of action? Binds FK binding protein, inhibits mTOR --> inhibits T and B cell response to IL-2

Sirolimus (Rapamycin)

Goal trough - Cyclosporin

200-300

Cyclosporin undergoes ______ metabolism and _____ excretion

Undergoes hepatic metabolism, biliary excretion

Goal trough - Tacrolimus

10-15

Major side effect - Sirolimus/ Rapamycin

interstitial lung disease

Which transplant drug has this method of action? Equine or rabbit polyclonal antibodies against T cell antigens

Anti-thymocyte globulin

Major side effect - anti-thymocyte globulin How can this be prevented?

Cytokine release syndrome - fevers, chills, pulmonary edema, shock - steroids and drugs used to try and prevent this

What factors does the PT measure? (5)

1, 2, 5, 7, 9

Does the PT measure the extrinsic or intrinsic pathway?

Extrinsic pathway

What factors does the aPTT measure? (8)

1, 2, 5, 8, 9, 10, 11, 12

What is the most important determinant in the PT?

Factor 7

Elevated trough levels are adjusted by ______ (decreasing the dose or decreasing the frequency)

decreasing the frequency trough levels that are too low are adjusted by increasing the frequency of the dose

Peak levels that are too high are adjusted by ______ (decreasing the dose or decreasing the frequency)

decreasing the dose Peak levels that are too low can be adjusted by increasing the amount of the dose

What organism most commonly causes acute lymphangitis. Treatment?

Group A Strep. Best treated with a PCN

What is the treatment for Hemophilia A?

Cryoprecipitate. It is rich in factor 8 and fibrinogen and will help coagulation in these patients.

How do you stop warfarin-induced skin necrosis?

Stop warfarin give vitamin K systemic heparin therapy

_____ is a potential infectious etiology found in HIV positive patients with bowel perforation

CMV

Von Willebrand's disease is associated with normal or abnormal platelets?

normal platelets

Von Willebrand's disease - associated with normal or prolonged bleeding time?

Prolonged bleeding time

What is the antidote to ethylene glycol poisoning?

Fomepizole

Treatment of methemoglobinemia?

Methylene blue

______ can be used to correct intra-op bleeding in patients with ESRD

DDAVP

Potential side effect - mafenide acetate

metabolic acidosis

potential side effect - silver nitrate

hyponatremia and methemoglobinemia

potential side effect - silvadine (silver sulfadiazine)

transient neutropenia

Breast - stereotactic needle biopsy reveals columnar cell lesions with atypia. Next step?

Proceed with surgical excision - frequent assoication with tubular carcinoma

injury to the thoracododorsal nerve and the muscle it innervates

weakened arm pull-ups and adduction. Innervates the latissimus dorsi muscle

injury to the long thoracic nerve and the muscle it innervates

winging of the scapula, inability to raise arm above shoulder serratus anterior

injury to the intercostobrachial nerve

numbness and pain of the upper inner arm

What is the significance of LCIS? Is it pre-malignant?

It is a tumor marker for breast cancer but it is not a premalignant lesion Therefore, negative margins are not required when performing an excisional biopsy

Why is the upper outer quadrant of the breast the most frequent site of both benign and malignant breast disease?

abundance of epithelial tissue

LCIS is associated with the development of what kind of breast cancer?

Ductal cancer

What medicine can you give patients with LCIS?

tamoxifen - has been shown to reduce the risk of developing cancer

BI-RADS 2 on mammogram

benign

BIRADS 1 on mammogram

negative for malignancy

BIRADS 0 on mammogram

incomplete - workup requires further evaluation

What is the relevance disease? phenylethanolamine-N-methyltransferase (PMNT) -

Pheochromocytoma Converts norepinephrine to epinephrine

_____ is the most important component of the TNM staging for well differentiated thyroid cancer

Age Stage 3 and 4 do not exist for patient under 45 with well differentiated thyroid cancer