Random

Question 1

B calcaneal frx a/w what other injury?

Answer 1

Lumbar compression frx

Question 2

Best predictor for extubation? How calculated?

Answer 2

RSBI, RR/Tv, >105 is highly predictive

Question 3

When should warfarin be held for elective cases?

Answer 3

Nonvalve afib with chads2vasc<5 for 5 days prior

Question 4

Bedrest and activity restrictions for ped splenic injuries?

Answer 4

Lift bedrest when HDS, activity grade + 2 weeks

Question 5

Pt develops pancreatic pseudocyst and PVT, next step?

Answer 5

Egd to look for varices

Question 6

CT characteristics of hepatic adenoma? Risks?

Answer 6

CT: heterogenous mass w rapid enhancement during arterial phase
Risks: bleed»malignant transformation

Question 7

Hepatic hemangioma CT characteristics?

Answer 7

Low density and peripheral nodular enhancement over time

Question 8

RAAS overview?

Answer 8

Liver makes angiotensinogen, renin from kidney cleaves to At1, ACE from lungs cleaves to At2, which acts on kidneys, adrenals, vessels, pituitary

Question 9

Septic vs neurogenic shock (CI, SVR, CVP)

Answer 9

Septic: CI up, SVR and CVP down
Neurogenic: all down

Question 10

How to determine study design?

Answer 10

Was exposure assigned? Tells you controlled or not (random?)
What was the study direction? If exposure then outcome it’s cohort, if exposure before outcome it’s case control, if at same time is cross sectional

Question 11

Best intervention for biliary complication (bike leak)

Answer 11

ERCP (dx and tx)

Question 12

What circumstances should PD cath be removed?

Answer 12

Refractory peritonitis (doesn’t respond to abx, relapsing, repeat episode in 4 weeks)

Question 13

Lynch syndrome AKA? Mutation?

Answer 13

HNPCC; MSH6 (mismatch repair gene)

Question 14

FAP gene? PJS? Juvenile polyposis? Cowden? Lynch?

Answer 14

FAP: APC
PJS: STK11
JPS: SMAD4
Cowden: PTEN
Lynch: MLH/MSH/PMS

Question 15

Adenoid cystic carcinoma features

Answer 15

Spreads along nerves, common lung mets after dormant period

Question 16

Cerebral salt wasting vs SIADH

Answer 16

CWS signs of dehydration vs SIADH signs of hypervolemia (both have hypoNa, hyperOsm urine)

Question 17

RYGB shown to improve what conditions in best to worst order?

Answer 17

DM>HTN>HLD

Question 18

3 types of vagotomy and associated nerves?

Answer 18

Truncal: main trunk of both vagus ligated

Selective: ant and post nerves of Latarjet ligated resulting in pyloric denervation so need pyloric drainage

Highly selective: parietal vagotomy, ligate nerves to parietal cells in stomach serosa (fundus and body), does not denervate pylorus

Question 19

Most important negative prognostic factors for thyroid ca

Answer 19

Distant mets>age over 55, local extension, size over 4cm, Male

Question 20

What are the BCAA?

Answer 20

Leucine, isoleucine, valine (LIV)

Question 21

Anaphylaxis after blood transfusion?

Answer 21

Likely IgA deficiency due to host anti-IgA abs vs transfused IgA abs

Question 22

Electrolyte rearrangements with TLS?

Answer 22

HypoCa, hyperuremia, hyperK, hyperphos

Question 23

Horseshoe abscess incision?

Answer 23

Posterior midline to drain deep post anal space and B incisions to drain ischiorectal fossae

Question 24

Preferred vte ppx?

Answer 24

LMWH
Use UFH if renal insufficiency

Question 25

What’s the main reason for interval appendectomy after perf appendicitis? Risk of recurrent appendicitis if treated w abx alone/drainage?

Answer 25

Neoplasm Recurrence rate 5-38%

Question 26

What do lateral and medial pec nerves innervate?

Answer 26

Lateral: pec major Medial: pec major and minor

Question 27

What does long thoracic innervate?

Answer 27

Serratus anterior; lose abduction, winged scapula

Question 28

Gene and lesions associated with MEN1, 2A, 2B

Answer 28

1: MEN1; pituitary, parathyroid hyperplasia, pancreas 2A: RET; parathyroid, medullary thyroid ca, adrenal pheo 2B: RET; medullary thyroid ca, adrenal pheo, GI, marfanoid habitus

Question 29

Spontaneous skin ulceration years after chronic lymphedema?

Answer 29

Lymphangiosarcoma; need incis bx/WLE

Question 30

Chyle leak management

Answer 30

First line is low fat diet with med chain TG, can add octreotide to dec output, npo + tpn if diet fails, embol w lymphangiography, surgical ligation

Question 31

What defines postop panc leak?

Answer 31

Drain with amylase>3x serum amylase on pod3

Question 32

What are carotid body tumors? How to resect?

Answer 32

Paraganglioma at carotid bifur. Try to excise. Rtx if encase carotids

Question 33

What index serves best for geriatrics undergoing emergency surgery to predict postop outcomes?

Answer 33

Frailty index

Question 34

Adverse effects of mafenide acetate? Silver sulfadiazine? Silver nitrate?

Answer 34

MA: metabolic acidosis SS: neutropenia, tcp SN: methemoglobinemia

Question 35

MC anterior mediastinal mass? Posterior?

Answer 35

Anterior: lymphoma Posterior: neurogenic (present w mass effect or horners)

Question 36

When is resection of HCC contraindicated?

Answer 36

Cirrhosis, PVH Need txp

Question 37

What is glucagon dose?

Answer 37

1mg, relaxes oddi

Question 38

What are the lung fissures?

Answer 38

Left: major/oblique Right (3 lobes): minor/horizontal separates upper from middle and major separates middle from lower

Question 39

MC vitamin def in bariatric patients? Sx?

Answer 39

Vitamin D: fatigue, weak, dec bone density

Question 40

How does dobutamine work?

Answer 40

Beta-1 agonist in heart to inc contractility, at higher doses exerts beta-2 effect to vasodilate

Question 41

Tx order for MEN1?

Answer 41

Hyperparathyroid first w four gland resection and autoimplant First sx is hyperCa

Question 42

Which type of lung ca causes hypoNa? How? Which causes hyperCa?

Answer 42

Small cell: SIADH Squamous cell causes hyperCa via rPTH peptide

Question 43

Surgical tx for massive lower GIB w unclear source?

Answer 43

TAC + EI

Question 44

What can cause EPO to fail? Need to check prior to starting

Answer 44

Iron deficiency, check Fe studies

Question 45

How is a pyloromyotomoy done?

Answer 45

Longitudinal incision along anterior pylorus extending to nonhypertrophied pylorus, separate muscle fibers, watch for gastric mucosa bulging out to signify completeness

Question 46

Loss of pitch phonation after thyroidectomy?

Answer 46

Injury to external branch of SLN unnerving crycothyroid (internal branch is purely sensory)

Question 47

Fevers, chills, mesenteric mass in post txp patient?

Answer 47

Lymphoma

Question 48

When do you not repair ventral hernias electively?

Answer 48

BMI>50, smokers, a1c>8

Question 49

Fluoroquinolones and moa?

Answer 49

Cipro/levoflox; inhibit DNA gyrase

Question 50

Sx of hypermag? Tx?

Answer 50

Paralysis, hypotension, confusion Calcium first then hydrate and diurese

Question 51

What would favor earlier elective intervention for sigmoidectomy for divertic?

Answer 51

Immunosuppression (txp pt, alcoholics, chemo pt)

Question 52

What’s a non recurrent laryngeal nerve? Associated with?

Answer 52

Aberrant course, inc risk of injury; on the R a/w arteria lusoria or aberrant R SCA; on L a/w right side aortic arch

Question 53

Absolute CI to BCT?

Answer 53

First trimester, inflammatory breast ca, inability to achieve clear margins, diffuse microcalcs

Question 54

Tx for anal squam cell carcinoma?

Answer 54

Chemortx; APR if still bad; maybe WLE if away from sphincter and get 1cm margins

Question 55

Insulinoma sx and tx?

Answer 55

Fasting hypoglycemia, sx resolve w glucose admin, high serum c-peptide Enucleate if <2cm, resect if >2

Question 56

Phases of GVHD

Answer 56

1. Recipient conditioning: damage to recipient tissue 2. Donor T cells differentiate into th1 and th17 lineages 3. Tissue dysregulation