SCORE Flashcards
(150 cards)
1
Q
Pt has a 50% TBSA 3rd degree flame injury with soot in the sputum. Serum carboxyhemoglobin is 30%. The PaO2 is 150 torr (FIO2 1.0) after intubation. the next step in management is?
A
Initiate low tidal volume ventilation. Pts with 50% TBSA are at risk of sustaining complications related to resuscitation, so a hyperbaric chamber is not appropriate. With a PaO2/FiO2 ratio <200, they have significant lung injury and are at risk for ARDS. ventilation with low tidal values allows for hypercapnia, the low volume/high frequency ventilation tolerates a respiratory acidosis to keep intrathoracic pressures below 40cm H20 and decrease barotrauma
2
Q
what 2 bugs are associated with lymphangitis?
A
staph aureus and strep pyogenes
3
Q
what is sepsis?
A
a life threatening organ dysfunction due to dysregulated response to infection
4
Q
what is qSOFA?
A
a combination of 3 abnormalities: hypoTN, inc RR, AMS
5
Q
what is septic shock?
A
HypoTN in which you need pressors to maintain a MAP <65mmHg AND elevated serum lactate >2mmol/L
6
Q
What is Light’s Criteria?
A
Exudative Effusions will have a pleural fluid protein/serum protein>0.5. Pleural fluid LDH/Serum LD>0.6. Pleural fluid LDH > 2/3 the upper limit of serum LDH normal
7
Q
what is the best means of diagnosis of an Empyema?
A
CT
8
Q
Does intraoperative cholangiograms reduce the risk for biliary ductal injury?
A
No
9
Q
Most common approach for resecting atrial myxomas
A
Median Sternotomy and L and R atriotomies
10
Q
Most common cause of adrenal insufficiency is…
A
autoimmune disease
11
Q
How to treat H. Pylori?
A
Clarithromycin, Amoxicillin, and a PPI (omeprazole). Metronidazole can be used in a penicillin allergy
12
Q
Risk factors for the development of pseudoaneursym following peripheral arterial intervention
A
- larger sheath size 2. heavily calcified arteries 3. obesity 4. need for concurrent anticoagulation 5. combined arterial and venous puncture 6. inadequate post catheterization compression
13
Q
what is the vicious triad in acute coagulopathy of trauma and shock?
A
hypothermia, acidosis, clotting factor consumption
14
Q
What are the zones of the neck?
A
I-below the cricoid to the level of the clavicles
II-between the cricoid to the angle of the mandible
III- Above the angle of the mandible to the base of the skull
15
Q
Which of the follow is not an indication for liver transplantation?
A
Colon Cancer
16
Q
what is associated with sodium warfarin-induced skin necrosis?
A
Protein C deficiency
17
Q
What does Gastric tonometry measure
A
lumin PCO2
18
Q
where does lymphatic drainage of the testes follow?
A
R: paracaval and interaortocaval lymph nodes
L: para-aortic lymph nodes
19
Q
what injury is common in L nephrectomy?
A
Pancreas
20
Q
what is the cutoff function for nephrectomy?
A
15-20%
21
Q
Pt is undergoing a laparotomy for hysterectomy. She is having massive pelvic hemorrage, which has not been controlled. How do you control the bleeding?
A
ligation of the hypogastric artery, anterior branch (internal iliac) - will reduce pulse pressure to the pelvis. Collaterals will provide flow to prevent necrosis. AVOID the posterior branch, decreased collaterals.
22
Q
how do you improve patient survival rate in ovarian cancer?
A
operative debulking: disease, TAH, bl salpingooophorectomy, omentectomy
23
Q
Gastrinomas are most often found where?
A
In the gastrinoma triangle: R of the superior mesenteric vessels (cystic and common bile ducts), head of the pancreas, duodenal wall (2nd and 3rd portions)
24
Q
MEN 1 syndrome
A
Parathyroid, Pancreatic tumor, Pituitary tumor
25
MEN IIa
Medullary thyroid cancer, pheochromocytoma and parathyroid tumors
26
MEN IIb
Medullary thyroid cancers, pheochromocytomas, marfinoid habitus and mucosal neuromas
27
in asymptomatic relatives of patients with MEN IIa, risk of medullary carcinoma can be assessed how?
Identification of a RET proto-oncogene mutation- MEN 2 is a gain of function autosomal dominant gene.
28
what is a risk of doing an interscalene block?
hemidiaphragmatic paralysis due to accidental phrenic nerve block
29
what are the sx of a myxedema coma?
hypothyroidism, hypocortisolemia, hypoventilation, hypothermia, hyponatremia, hypotension, hypoglycemia, and infection
30
what do you use each biostats test for?
1. wilcoxon test
2. paired t-test
3. Kruskal-Wallis test
4. Linear regression
1. wilcoxon test- relationship between orindal variables (satisfactions scores in before/after treatment), or comparing baseline age participants
2. paired t-test - continuous data
3. Kruskal-Wallis test - ordinal data from three or more groups
4. linear regression studies are for the association between 2continuous variables
31
Genes are associated with which thyroid cancer?
1. RET mutation
2. PAX8/PPARgamma
3. p53
4. BRAF-V600
1. familial medullary thyroid carcinoma
2. follicular thyroid cancer
3. anaplastic thyroid cancer
4. papillary thyroid carcinoma
32
what are ordinal variables?
have 2+ categories that are ranked - ex. pt asked to express pain level from 1-10
33
what is the other name for the Wilcoxon rank-sum test?
Mann-Whitney U Test
34
what do you administer to help reverse local anesthetic toxicity?
IV Intralipid
35
which is correctly paired?
1. Cohort study - odds ratio
2. Case control study - odd ratio
3. Case control study - relative risk
4. Randomized controlled trial - odds ratio
2. Case control study - odds ratio
36
when disease incidence increases, what happens to positive predictive value and negative predictive value?
PPV will increase and NPV will decrease
37
An investigator is finding an associationg between exposure to a toxin and gastric cancer. She sends a survey to 1000 pts with the disease and 1000 pts without the disease. what sort of study is this and what statistical measure should be reported to summarize the findings?
case-control study - cases are selected on whether someone has the disease or not. Odds ratio
38
which non-depolarizing relaxants is preferred in intubation of patients with hepatic or renal dysfunction?
atracurium
39
what does secondary analysis mean?
analyzing existing data that has been collected to answer a different research question
40
Renal Injury Scale in Trauma
| I-V
I-Contusion with microscopic or gross hematuria, hematoma that is subcapsular and nonexpanding
II- Hematoma that is perirenal but confined to renal retoperitoneum. Laceration <1cm parenchymal depth without extravasation.
III- laceration >1cm without extravasation
IV- Parenchymal laceration extending through the renal cortex, medulla, and collecting system. Main renal arter or vein injury
V-Avulsion of the renal hilum and completely shattered kidney
41
which classification of renal injuries do NOT need to be operated on?
I-III
42
what is the maximum safe dose of Lidocaine with Epi? Without Epi?
Lido with Epi = 6-7mg/kg
| Lido WITHOUT Epi = 4-5mg/kg
43
what is the reversal agent for rocuronium?
a chelating agent, sugammadex. Or in general, a cholineesterase inhibitor (eg. neostigmine) can be given to inc the amount of AcH
44
What happens to the HR, SV, MAP, and SVR during pregnancy?
HR inc, SV inc, MAP dec, SVR dec
45
what is an absolute contraindication to methotrexate
breastfeeding
46
which anticoagulant should be started for a pt that has a DVT on POD5?
LMWH
47
what is the maximum exposure that a pregnant woman can have?
5 rad (0.05 Gy)
48
what is the apology law and which state doesn't have one?
Where "Im sorry" statements or expressions are not admissible in court. New York
49
how do you reverse dabigatran?
Idarucizumab - a monoclonal antibody to dabigatran
50
what is the average amount of radiation that a fetus receives during a CT scan?
2.5 rads
51
which pain medication has a "black box warning" for post tonsillectomy/adenoidectomy?
codeine
52
Cardiac Ejection Fraction is falsely increased in which two heart conditions?
mitral insufficiency and ventricular septal defects
53
name 6 proserotenergic opoids?
fentanyl, methadone, meperidine, tramadol, dextromethorphan, and propoxyphene
54
what is the best reversal for warfarin?
four factor prothrombin concentrate - includes factors II, VII, IX, X
55
what occurs during refeeding syndrome?
insulin secretion, hypoK, hypoCa, hypoPhos
56
What is the operation of choice for an injury of the proximal biliary tree?
Roux-en-Y hepaticojejunostomy
57
what is cholesterolosis in the gallbladder?
multiple cholesterol polyps (cholesterolosis) typically are pedunculated, hyperechoic, and do not have posterior shadowing
58
when do you perform an ERCP with stone extraction and sphincterotomy?
when the patient is in septic shock (probably in the ICU) and cannont tolerate any procedure that would require a laperotomy (CBD exploration, choledocoenterostomy, biliary T tube placement).
59
Why do you see Prolong PT in pts with CBD obstruction?
The biliary obstruction deprives the SI of the bile necessary to break down fats and absorption of fat soluable vitamins, specifically vitamin K which is a cofactor for factors VII, IX, X
60
Which test would be a good reproduction of biliary colic as well as identify if a patient would benefit from transduodenal sphincteroplasty?
Morphine - neostigmine (Nardi) test. Used to identify sphincter of Oddi dysfunction by Morphine contracts the sphincter and neostigmine contracts the biliary system
61
what chemotherapy is recommended for patients with hepatobiliary cancers?
gemcitabine and cisplatin
62
Pts with deterioration of renal function and angiographic evidence of severe disease and renovascular HTN most likely benefit from:
Endovascular intervention OR Open revascularization?
Open revascularization (except those with fibrodysplasia)
63
Claudication is a strong predictor of what?
Non fatal MIs
64
Why do we bridge warfarin initiation with heparin?
Warfarin blocks vitamin K epoxied reductase (that deactivates vitamin). Then K dependent factors (factors II, VII, IX, X, protein S and protein C) are unable to work. Protein C and S (anticoagulants) have shorter half lives than Factors II, VII, IX, and X (pro coagulants), there is a brief time of hypercoaguability.
65
2 incisions made for a LE fasciotomy
Anteriolateral and Posteriomedial
66
Which is NOT associated with inc mortality after AAA repair?
- Angina pectorals
- COPD
- LVH
- >69yo
- Hx of CVA
Angina pectorals
67
In a coagulopathic patient, which central venous access is contraindicated?
Subclavian veins - cannot compress
68
Where is the best place to put a dialysis catheter?
R IJ
69
What is the most common cause of Prosthetic AV access thrombosis 1-2 years after placement?
Stenosis of the graft-venous anastomoses
70
what can be used in men for breast cancer?
tamoxifen
71
How does heparin work?
Uses anti thrombin to inhibit formed thrombin and factor Xa
72
Where do you put the Macintosh blade?
Behind the vallecula (space between the epiglottis and back of tongue)
73
What pressors to use in acute liver failure?
Norepinephrine and Vasopressin - NE inc SVR without inc CO, Vasopressin counteracts splanchnic dilation
74
Pt with hx of alcoholism is now undergoing tetany and severe fasiculations, which electrolyte abnormality is probably present?
hypomagnesemia or hypocalcemia
75
44yo female with papillary carcinoma and lung mets, which stage of cancer does she have? (I-IV)
II - regardless of mets, people under the age of 45 have the best prognosis
76
Where do you find the parathyroid glands, upper and lower, in relation to the recurrent laryngeal nerve?
Lower glands are typically medial to the nerve, near the lower pole of the thyroid gland and tend to be anterior or superficial in the neck. Upper glands are lateral to the nerve, deep in the neck, and often are found near the tubercle of Zuckerlandl. The recurrent nerve is typically found in the tracheo-esophageal groove. Sometimes, upper glands can be found in the retroesophageal location, but this would be atypical for an inferior gland.
77
Where do you find the parathyroid glands, upper and lower, in relation to the recurrent laryngeal nerve?
Lower glands are typically medial to the nerve, near the lower pole of the thyroid gland and tend to be anterior or superficial in the neck. Upper glands are lateral to the nerve, deep in the neck, and often are found near the tubercle of Zuckerlandl. The recurrent nerve is typically found in the tracheo-esophageal groove. Sometimes, upper glands can be found in the retroesophageal location, but this would be atypical for an inferior gland.
78
The site (organ) of tumor most likely responsible for ectopic adrenocorticotropic hormone production as a cause of Cushing`s syndrome is the
lung
79
A 56-year-old woman who has had radiation therapy to the head and neck has a 2-cm mass in the right thyroid lobe. The most likely diagnosis is:
papillary thyroid cancer
80
A 56-year-old woman who has had radiation therapy to the head and neck has a 2-cm mass in the right thyroid lobe. The most likely diagnosis is:
papillary thyroid cancer
81
A single focus of chief cells, surrounded by a compressed rim of normal tissue describes what kind of parathyroid disease?
Parathyroid adenoma
82
A diffuse proliferation of clear cells with little remaining normal tissue, describes which kind of parathyroid disase?
parathyroid hyperplasia
83
The presence of Reed-Sternberg cells, describes which diease
hodgkin lymphoma
84
The presence of Reed-Sternberg cells, describes which diease
hodgkin lymphoma
85
Carcinoembryonic antigen and calcitonin are markers for which thyroid cancer?
Medullary thyroid carcinoma
86
which marker can be followed for papillary thyroid carcinoma?
thyroglobulin - Papillary thyroid cancer (PTC) is a thyroid-stimulating hormone–dependent cancer
87
what is Podofilox, and what is it use for?
Podofilox is a cream created from one of the active ingredients in podophyllin. Because podofilox is much less irritating to surrounding tissues, it can be prescribed for home use of genital/anal condyloma
88
Where should a lateral sphincterotomy be performed?
Right lateral
89
Which of the following is the most common complication following excisional hemorrhoidectomy?
urinary retention
90
You have recommended lateral internal sphincterotomy. What is the long-term risk of fecal incontinence to liquid and solid stool?
Less than 5%
91
In low rectal cancer, the acceptable distal margin from the tumor edge is (????) cm or greater. In mid or high rectal cancers, the aim is to achieve a distal margin of (????) cm.
1; 5
92
Surgical management (LAR or APR) of advanced local rectal cancer should be time for (????) after completion of neoadjuvant radiation
5-10 weeks
93
Retrospective reviews have found (LAR vs APR?) to be associated with improved survival and decreased local recurrence rates in mid and low rectal cancers. Very distal rectal cancer (often extending into the anal canal) managed by APR has the worst rate of survival and recurrence
LAR. Very distal rectal cancer (often extending into the anal canal) managed by APR has the worst rate of survival and recurrence
94
what is Alvimopan?
Alvimopan is an opioid antagonist that is peripherally acting and does not cross the blood brain barrier. In several studies, it has been demonstrated to decrease time to resumption of bowel function described as flatus, bowel movement, or toleration of regular diet by 15-24 hours. It has been approved by the FDA for perioperative use after partial large or small bowel resections with primary anastomosis.
95
what is a sitz marker study?
ingestion of radiopaque markers followed by daily radiographs, which allows for monitoring of the radio-opaque markers as they pass through the colon.
96
Treatment for low rectal fistula? High rectal fistulas?
Low - rectal advancement flap. High - involves resection of the involved bowel with primary re-anastomosis if possible.
97
where are these cancers most likely found in the small intestine?
1. adenocarcinomas
2. Non Hodgkin's lymphoma
3. Carcinoid
4. GIST tumors
1. duodenum or proximal jejunum
2. spares the duodenum
3. rare, distal ileum
4. rare overall in the small intestine, no particular place
98
what do you give a patient with a carcinoid tumor experiencing hypotension that is not responding to IVF or vasopressors?
Somatostatin
99
what is the common complication following reversal of a loop ileostomy?
SBO
100
Risk factors for Non hodgkins lymphoma in the small bowel
transplant, celiac disease, and HIV
101
where are these things absorbed?
1. iron
2. bile salts
3. B12/intrinsic factor
1. duodenum
2. ileum
3. terminal ileum
102
people with extensive ileum resection develop oxalate urinary stones, why?
because there will be a decrease of fat maladigestion and malabsorption, leading to fats being digested to fatty acid in the colon by bacteria. The fatty acids bind to calcium, making the Ca unavailable to bind to oxalate. The excess oxalate is reabsorbed resulting in increased oxalate load in the urine.
103
Peyer`s patches are primarily responsible for the local synthesis of
IgA
104
what does Papaverine do?
vasodilator agent that does not increase intestinal O2 uptake
105
what is a Cameron’s lesion?
chronic enteric blood loss as a result of mechanically induced linear erosions at the level of the diaphragm within the hiatal hernia
106
In a patient with gastrinoma, the most effective drug for controlling duodenal ulceration is
a PPI
107
Describe where the gastric ulcers are locations and associations (I-V)
I - lesser curvature, not associated with acid secretion
II - lesser curvature, associated with acid hypersecretion
III - prepyloric region, associated with acid hypersecretion
IV - in the cardia near the gastroesophageal junction, not associated with acid secretion
V - diffuse and associated with NSAID use
108
In patients with a hypofibrinogenemia-associated coagulopathy, the most appropriate management is the administration of
cryoprecipitate - contains von Willebrand factor complexed with Factor VIII and fibrinogen making it the most appropriate therapy for hypofibrinogenemia. FFP also contains fibrinogen, but also contains other clotting factors and needs to be ABO compatible
109
Sodium warfarin sensitivity is associated with an abnormality in what?
Polymorphisms of CYP 2C9 have been identified that result in warfarin sensitivity in individuals with these variations.
110
Which factor converts fibrinogen into fibrin, activates multiple factors in the coagulation cascade, and activates platelets.
Thrombin
111
when does a pneumothorax become a problem?
symptoms or >3cm
112
How much fluid in a plural effusion is needed to show up clinically? on chest xray?
Generally, 500 mL effusion is necessary to be detected on clinical exam; 300 mL of fluid will cause blunting of the costophrenic angle on upright chest x-ray.
113
A 76-year-old man presents to the emergency department with new-onset shortness of breath. A chest radiograph reveals a moderate size left-sided pleural effusion. Thoracentesis is performed yielding blood tinged fluid. The pleural fluid analysis reveals lactate dehydrogenase 1100 IU/L, glucose 35 mg/dL, pH 7.2, and cytology 70% lymphocytes. What is the most likely diagnosis?
Malignant mesothelioma - although this indicates that it is exudative (high LDH, low glucose, low pH, high lymphocytes), the fact that it is blood tinged and NOT purulent suggests mesothelioma vs. empyema
114
after successful management of a first-time primary spontaneous pneumothorax with a chest tube, what is the risk of recurrence?
60%
115
Without intervention (including tube thoracostomy), how quickly does a pneumothorax resolve?
1% per day
116
```
A 70-year-old woman with a penicillin allergy resulting in anaphylaxis is evaluated in your office and diagnosed with symptomatic cholelithiasis. She is scheduled for elective cholecystectomy. What would be an appropriate choice of prophylactic antibiotic?
A. None required
B. Cefazolin
C. Metronidazole
D. Fluconazole
E. Clindamycin
```
Clindamycin. Cefazolin is a good alternative for someone WITHOUT a pencillin allergy
117
associated with mutations in p53 or hCHK2
Li-Fraumeni syndrome
118
what is the standard adjuvant therapy for gallbladder carcinoma?
Gemcitabine with cisplatin
119
which of the tumor markers has the greatest specificity for hepatoblastomas
alpha feto proteins
120
most common genetic mutation in pancreatic cancer
k-ras. CA 19-9 is the most common oncofetal protein in pancreatic cancer
121
A 35-year-old man undergoes an uncomplicated right axillary lymphadenectomy for melanoma. Three of 19 lymph nodes are positive for melanoma. Which one of the following adjuvant therapies can be offered?
Ipilimumab
122
Normal cellular proliferation is inhibited by
TGF-b
123
Both forms of MEN-II are associated with mutation of the ____ proto-oncogene
Ret
124
how mank kcal are there in fat?
9 per gram
125
what are some AEs of Meperidine?
accumulation even in renally intact patients to cause excitation and seizures
126
Which amino acid is conditionally essential in a septic patient?
Glutamine
127
Hydrated glucose in parenteral nutrition provides _____ kcal/g, whereas oral carbohydrates provide _____ kcal/g
3.4; 4.0
128
low to moderately stressed state require _______ kcal/kg per day
25-30 kcal/kg per day
129
Memorize this: During prolonged fat-free TPN, essential fatty acid deficiency may become apparent, manifested by a dry, scaly dermatitis and loss of hair. Copper deficiency is associated with microcytic anemia. Inadequate stores of vitamin K can be manifested as a coagulopathy. Supplemental vitamin K should be administered intramuscularly because it is unstable in the TPN solution. Chromium deficiency can cause glucose intolerance eczematoid rash on his face, trunk, and intertriginous areas is zinc deficiency.
Memorize
130
Which hormone will relax the sphincter of Oddi?
glucagon
131
where do you approach an intrathoracic esophageal injury?
R posterolateral thoracotomy
132
which chromosome is menin found on. which disease is this associated with?
11; MEN1
133
treatment of choice for laryngeal trauma
tracheostomy
134
Lobular carcinoma in situ is associated with at least ____ lifetime risk of breast cancer.
20%
135
for a female, which screenings are needed before age 50?
Mammogram, skin surveillance, gyn w pap smear. Does NOT need a colonoscopy
136
with neuroleptic malignant syndrome can you substitute one of the new anti-psychotics (risperidone) with halodol?
No
137
TNM staging of a woman with a 2.5cm right breast invasive ductal carcinoma with 2/5 sentinel lymph nodes positive but no distant metastasis?
T2N1M0
138
Without intervention (including tube thoracostomy), how quickly does a pneumothorax resolve?
1% per day
139
preferred method for thrombosed popliteal aneurysm
open, endovascular for comorbidities
140
what to do if a PEG tube falls out before 6 weeks postop?
place an NG tube to prevent spillage
141
what are the signs of acute limb ischemia?
pulselessness, pain, pallor, poikilothermia, paresthesia, and paralysis
142
The patient received a total of 12 L of crystalloid and blood intra-operatively. On postoperative day 1, blood pressure is 95/60 mmHg, pulse is 140 bpm, and urinary output is 20 mL/hr. EKG and enzymes reveal no evidence of ischemia, but confirm atrial fibrillation. Which of the following is the most appropriate management plan for this patient?
Metoprolol for rate control followed by IV furosemide
143
What is the most appropriate location of an epidural catheter for a lower abdominal operation such as a total abdominal hysterectomy
T11 - All epidural analgesic agents are segmental in nature and limited in anatomic spread and should be placed appropriately to affect appropriate dermatomes corresponding to the area of the operation.
144
how do GIST tumors spread?
hematogenously
145
Symptoms secondary to carcinoid syndrome are ameliorated by _______?
Somatostatin - which is why octreotide works
146
Is the pain in Mondor's acute or chronic?
acute
147
primary spontaneous pneumothorax, what is the risk of recurrence?
60%
148
During thoracoscopy for a recurrent malignant effusion that was previously managed with three prior thoracenteses in the last 6 weeks, you note tumor caking the visceral and parietal pleura. The lung does not fully expand during a Valsalva maneuver. The most appropriate treatment for the effusion is:
tunneled pleural catheter
149
continuous variable in two samples in order to determine whether the difference between the two observed means exceeds the difference expected to occur by chance.
Student's t test
150
child disease that has abdominal aortic coarcation and/or renal artery stenosis(es).
NF-1
