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1
Q

BL Adrenal Hyperplasia

A

Mitotante

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2
Q

Aldosterenoma (Conn) Labs

A

Hypokalemia
A:R&raquo_space;20

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3
Q

When to do colectomy UC

A

First sign of dysplasia - usually 10 years after diagnosis

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4
Q

How to Stage Gastric CA

A

EGD BX
CT CAP / PET
Endoscopic US for staging if no mets

Most will get neoadjuvant chemo – repeat staging after this

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5
Q

BX for GIST - what do you see

A

Spindle cells, CD 117, CKIT+

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6
Q

Adjuvant for GIST

A

Imatinib - TK inhibitor – target Exon 9 / 11 (if 9, need higher dosing)

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7
Q

Hx for Gastric Stff

A

Smoking, PPI, fam / personal CA, prior scope, prior h pylori treatment

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8
Q

Imaging workup for suspicious GB

A

CT CAP and MRCP to better eval US findings

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9
Q

Critical View of Safety

A

Cystic duct, GB inferior border and common hepatic duct cleared of tissue
Must see cystic plate / liver bed in fossa with only 2 structures entering the GB

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10
Q

UC screening

A

Screen 8 years after UC diagnosis
C-Scope annually with circumferential bx every 10 cm for 33 bx

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11
Q

Adenomatous polyp screen

A

Repeat at 3 years if 3+ or over 1cm

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12
Q

What if you can’t do full scope in colon ca

A

CT colonography or enemagram

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13
Q

Lynch - when to scope and remove colon

A

Scope at 25 and annual, EGD 35
Recommend total proctocolectomy

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14
Q

Tumors assoc with FAP

A

Thyroid, desmoid, brain, colon, epidermal cyst

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15
Q

When to consider transanal rectal excision

A

Under 3 cm, under 1/3 circumference
Under 8 cm from verge
Mobile
Can get 3mm margin
No lymphovascular or perineural invasion

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16
Q

T 2 Rectal CA

A

Can do upfront surgery with LAR or APR
T3 invasion of perirectal tissue, needs neoadjuvant chemoradition therapy
If preop LN dx - preoperative XRT

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17
Q

when to do neoadjuvant xrt in rectal ca

A

T beyond muscularis or nodes
then re-stage prior to LAR or APR

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18
Q

Medical therapy - anal fissure
And if that doesn’t work?

A

Hydrate, fiber, topical nitro / lido / nifedipine
Then botox to internal sphincter
Then lateral internal sphincterotomy

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19
Q

Follow up for appendiceal NET

A

If over 2 cm, incomplete resection, mets or goblet
Serial plasma chromogranin A, CT CAP

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20
Q

What to assess in acute IBD flare
What must you rule out

A

HD stability
weight loss
anemia
nutrition
duration of steroid / biologic tx
Rule out cdiff / cmv

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21
Q

Neoadjuvant Chemo for Esoph
What are the next steps?

A

CROSS - Carboplatin, paclitaxel, radiation
Repeat labs (nutrition), EGD w/ EUS / BX and PET CT / CAP w/ Contrast

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22
Q

Test for Esoph Perf, and what order do they go?

A
  1. CXR
  2. Esophagram with gastrograffin
  3. thin barium

** no gastrograffin for high aspiration risk

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23
Q

Post op care after intervention for bleeding gastric ulcer

A

ICU, serial HH, PPI, Coags

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24
Q

What med can slow down ECF output

A

Octreotide

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25
What contrast for woods lamp? Spy?
Woods lamp -- Flourescene Spy - ICG
26
Plan for colon ca in setting of Lynch syndrome and mismatch genes
If Lynch -- total abdominal colectomy
27
What if woman with Lynch
TAC and hysterectomy/oopherectomy
28
What to do on c scope for acute flare of IBD
Ruel out infectious Do bx for CMV
29
1st Line Medical mgmt of severe UC What do you monitor
IV steroid - monitor bm frequency, bleeding, wbc and crp
30
What if no response to initial steroids in severe IBD flare
Start infliximab and reasses in 5-7 days with repeat endoscopy
31
What if no response to steroid / infliximab?
Surgery
32
Indications for surgery in UC
Toxic megacolon Perforation Fx medical management Dysplasia / Cancer
33
Tx for high output ileostomy
Aim for under 1.2 L Silium Fiber Loperamide (2 tabs / 4x daily) Then lomotil Then: Somatostatin, oral coating, tincture of opium
34
What to say when ordering CT w/ IV
If Cr normal on my labs, i would get a CT with iv contrast
35
Bleeding GI patient - what labs?
CBC, Coags, T/S, Lactic
36
C scope timing for bleeding
Admit, resuscitate and give blood for 24 hours Trend h/h Perform C-scope following bowel prep
37
When to scope after diverticulitis
8-12 weeks following episode, perform c-scope to rule out CA
38
What tests for female with lower abdominal pain
HCG, UA, transvaginal US -- plus all usual suspects
39
Hemangiom
Nodular peripheral/centripetal enhancement
40
FNH
Central scar
41
HCC
Hypervascular pattern with arterial enhancement and RAPID washout on PV phase
42
Adenoma
Hyperascular on arterial phase
43
Liver met
Hypodense lesion
44
What extra tests for any anal scc
HPV / HIV
45
Atypical Causes of Fissure
HIV, syphillis, Crohn's or Neoplasm
46
What extra test in post pregnancy fissure
Anal manometry - don't want to do normal things for this if low sphincter tone - do sitz bath, fiber, hydration -- no dilt ointment, botox or LIST Do endoanal advancement flap
47
Anti-fast bacilli and breast granulomas? dx and tx?
Granulomatous mastitis tx - steroids
48
what breast lesions grow with pregnancy
Fibroadenoma and fibrocystic disease
49
What normal breast ca staging tests can you not do in pregnancy What do you do instead
Typically PET CT CAP and bone scan - but in pregnancy you do chest xray and liver US
50
2nd trimester breast ca
Consult high risk ob No breast conservation - can't do radiation Rec: mastectomy and SLNBx with radioactive tracer (no blue dye) If trip negative -- adjuvant chemothearpy Breast conservation contraindicated in 1st / 2nd trimester -- safe answer is mastectomy If positive SLNBx -- do ax node dissection because you can't receive radiation Chemo can be given during pregnancy so neoadjuvant chemo can be used to push back the timing of radiation
51
What is 2nd trimester
Weeks 13 - 28
52
Who can not get breast conservation
Prior radiation 1st or 2nd trimester Collagen vascular disease Widespread microcalcs
53
Who needs staging with breast CA
Inflammatory Locally advanced Chest wall recurrence following mastectomy
54
Labs for milky discharge
endocrine - prolactin, bmp, thyroid, pregnancy
54
What if no enlarged parathyroid seen on US
Sestamibi scan or 4d CT scan (sestamibi better for reoperative parathyroidectomy) Negative imagig gets 4 gland exploration
54
Lab test specific for Graves
Thyroglobulin stimulating assay Thyroid stimulating ab
54
What labs to track with methimazole
CBC - agranulocytosis LFT - hepatotoxic Free t3 / t4 hould normalize, but TSH will take time to increase to normal
55
When to get thryoid scintigraphy
Single nodule in hyperthyroid patient -- to r/o solitary toixc nodule (Same as radioactive iodine scan) Can treat with radioactive iodine or a lobectomy to remove the nodule Dont biopsy a toxic nodule on US Scintigraphy for graves -- will show diffuse enlargement and uptake
56
WHen can you not do radioactive iodine for graves
If there is eye symptoms they can worsen with radioactive iodine
57
# [](http://) Benefit of total thyroid in papillary thyroid ca
Allows post op radioactive iodine for additional treatment Can use predictive models to determine risk from tumor factors to determine benefit of total thyroid
58
Who gets total thyroid for papillary ca
>4cm >Extrathyroid extension Metastatic ln on US or thyroidectomy BL nodules History of prior hypothyroidism
59
Tx for papillary thryoid with positive LN
If positive FNA of node -- total thyroid and ipsilateral central and lateral neck dissection (if node is lateral) Do a CT w/ IV to assess lymphadenopathy pre-op Can biopsy suspicious node in OR and send frozen - if positive, central neck dissection and total thyroid
60
Order for steps for indeterminate thyroid lesion
thryoid labs US - indeterminate FNA - Indeterminate Can repeat FNA and perform molecular testing vs doing lobectomy vs repeat US in 3 months with repeat FNA If molecular is positive -- do a dx lobectomy -- and if it is positive for
61
Treatment after lobectomy for papillary thyroid ca with 2cm and no extension or nodes
no additional treatement check thyroid funciton 6 weeks out US in 6 months and annually
62
Labs for adrenal
CBC, CMP, 1 mg low dexameth, dhea, acth, renin, aldosterone and plasma metanephrines
63
Labs for post op hypocortisol
Hyponatremia, hyperkalemia, tachy hypotensive
64
High risk for post adrenal ca mets
mitotic rate high ki 67 recommend serial imaging every 3-6 months with ct cap
65
Hyperaldosterone things
htn, hypokalemia, resistant bp -- check serum aldo, plasma renin and bmp
66
Medical treatment for hyperaldos
spironolactone
67
After elevating liver in right side adrenal what next
continue medially until you get to lateral side of the IVC - identify the vein by identifying the renal vein and going superior
68
Meds for treatment of BL adrenal cortisol hyperplasia
mifepriostone, ketoconazole and mitriapone
69
Labs for MEN
calcitonin, cea, calcium, pth and plasma metanephrines
70
Imaging for MEN 2
CTCAP and Cervical US After surgery monitor cea and calcitonin levels
71
Any LN positivity in melanoma needs--
staging with CT and PET CAP MSLT 2 - if small foci in 1 node and no extracapsular invasion can elect for close observation with mri and us
72
How to determine LN basin in melanoma
SPECT CT lymphosyntygraphy
73
Follow up melanoma
H/p 3-6 months Groin US q4 months for 2 years, then annual Annual PET CT
74
Imaging for Serous Cyst adenoma
benign older females microcystic honeycomb with stellate scar and no duct connection low cea and amylase in fna sample
75
# [](http://) Mucinous cyst adenoma characteristics
premalignant 4-5th decade female large macrocytic in body or tail Peripheal calcs high cea low amylase
76
IPMN
communicates with main duct high cea high amylase
77
Surveillance after IPMN
if high grade dysplasia -- semi annual EUS and MRI alternating
78
Best way to assess for pancreatic cancer
if resectable then resect if borderline then do EUS with FNA -- better than ERCP brushings BUt you need to put stent if hyperbili and getting upfront neoadjuvant therapy Get ca 19 9 after decompressing biliary system
79
Hyperdense pancreative lesion on arterial phase?
Think neuroendocrine tumor need grade and differentiation in pNETs
80
Sensitive test for metastatic pNET
Dotatate Pet CT -- well differentiated will light up on this remove any functional pNET
81
how to rule out functional pNET
fasting gastrin / insulin / glucose levels asymptomatic pNET get removed at 2 cm size or fast growth
82
what abx to include if salt water or fish ingestion
Doxy for VV
83
Big steps of code
* Big Steps o Initiate chest compressions o Establish IV access o Ensure good airway o Work through ABCs o End tidal over 10, 100 – 120 compressions / minute with 2 cm of chest wall movement allowing for recoil * ACLS Algorithm o Epi 1 mg IV given every 3-5 mins o Pulse check every 2 minutes o Other drugs that are included  Calcium  Magnesium  Amiodarone  Lidocaine connect AED intubate if can't bag mask
84
is pea a shockable rhythm
no pea is a non shockable rhythm
85
Reversible causes of coding
Hypovolemia Hypoxia Hypercarbia Hypothermia Hypo/hyperkalemia Tension pneumo Tamponade Thrombosis -- pulm or cardiac Toxins
86
2 shockable rhythms?
V tach and V fib
87
V fib or v tach -- which is synchronized
V tach you shock synchronized defibrillation V fib is unsynchronized shock
88

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