Stupid crap I can never remember

Question 1

screening intervals for Barrett’s esophagus

what’s low risk? how often?
what’s high risk? how often?
how often for high risk with low grade dysplasia?

Answer 1

low risk: less than 3cm, no dysplasia. every 2 years

high risk: more than 3cm or circumferential. every year

high risk with low grade dysplasia: every 6 months

high risk, high grade: q3 months, EMR

Question 2

flumanezil to treat what?

what is the dose? how much can you give?

Answer 2

to treat benzo toxicity

0.2mg IV loading dose over 30 seconds then up to 3mg

Question 3

felon vs. paronychia

Answer 3

felon: infection of the fingertip pulp. needs midline incision. lateral incision can hurt nerve bundle
paronychia: infection of the skin fold around the nail bed. needs lateral incision

Question 4

Merkel cell carcinoma:

CK-20? TTF-1?

sentinel node?

adjuvant radiation? chemo?

Answer 4

Merkel cell is CK-20 (+), TTF-1 (-)

small cell carcinoma of the lung is CK-20 (+), TTF-1 (+)

Yes. do sentinel node

yes radiation. no chemo

Question 5

lentigo maligna vs. acral lentiginous melanoma

what is the most common non-skin melanoma?

Answer 5

leitgo maligna is usually in older patients. LEAST AGGRESSIVE melanoma. rare in dark skin ppl

Acral lentiginous: nails, toes. most common subtype in dark skin ppl

most common non-skin melanoma: eye melanoma

Question 6

apocrine vs. eccrine gland

Answer 6

apocrine empties into hair follicles. blockage of this causes hidradenitis

eccrine empties into pores on the skin

Question 7

borders of superficial inguinal node dissection?

location and significance of cloquet’s node?

borders of the deep inguinal lymphadenectomy?

Answer 7

5cm above the inguinal ligament superiorly
adductor longus medially
sartorius laterally

cloquet’s node is below the inguinal ligament and medial to femoral vein. if (+) then do a deep node dissection

bifurcation of the common iliac artery into the external and internal iliac arteries. The caudal limit is the inguinal ligament.

Question 8

what primary tumor metastasizes to the skin the most?

Answer 8

breast goes to the skin most frequently

Question 9

hidradenitis staging differences

Answer 9

Hurley I: multiple abscess, NO SINUS tracts. most patients present with this

Hurley II: recurrent abscesses with sinus tracts, multiple separated lesions

Hurley III: diffuse involvement. multiple connected sinuses

Question 10

melanoma. (+) sentinel node but pt doesnt want node dissection. how do you surveil?

Answer 10

based on MSLT II okay to not do completion node dissection.

ultrasound of the nodal basin every 4 months for the first 2 years then every 6 months for the next 3 years

Question 11

margin for squamous cell cancer

Answer 11

low risk: 4mm

high risk (tumor depth > 2mm, moderately differentiated, size > 2cm): 10mm

Question 12

dermatofibrosarcoma protuberans. you do a margin negative WLE. are you done? what should you look for in pathology and do what if pathology shows this?

Answer 12

look for fibrosarcomatous changes in pathology. if this is present, then CT chest needs to be obtained

Question 13

mechanism of resistance to beta-lactam antibiotics found in MRSA?

Answer 13

alteration of the antibiotic target site.

Methicillin resistance in MRSA is mediated by horizontal transfer of the mecA gene. This gene encodes penicillin-binding protein 2a, which has low affinity for beta-lactams, in contrast to the other types of penicillin-binding proteins. The low binding affinity of beta-lactams renders the antibiotic ineffective in its action at that target site

Question 14

which immunosuppressant causes these side effects?

• GI bleed, pancytopenia
• Thrombocytopenia and poor wound healing

Answer 14

• GI bleed, pancytopenia: mycophenolate
  mycophenolate also has 50% diarrhea incidence
• Thrombocytopenia and poor wound healing: rapamune (sirolimus)

Question 15

difference between

• physician assisted dying
• voluntary active euthanasia
• Passive euthanasia
• rule of double effect

Answer 15

• physician assisted dying: when a physician prescribes a lethal dose of a medication for a patient to administer himself
• voluntary active euthanasia: when a physician knowingly administers a lethal medication to a patient per his request to end his life
• passive euthanasia: withdrawal of care
• rule of double effect: palliative medication given specifically to alleviate symptoms and it foreseeably, though unintentionally, hastens a patient’s death

Question 16

pts should quit smoking how many weeks before surgery?

what DLCO and FEV1 is needed to be able to undergo pneumonectomy?

Answer 16

4 weeks

DLCO > 60%, FEV1 > 60% for pneumonectomy

Question 17

who needs a screening CT for lung cancer?

what to do with 8mm ground-glass opacity?

Answer 17

all patients aged 55 to 80 with at least a 30 pack-year smoking history who either currently smoke or have quit in the past 15 years

lesions <1cm can be followed with follow-up CT

Question 18

risk of transmitting hep C from needle stick?

HIV?

Answer 18

1. 8% for hep C

0. 3% for HIV

Question 19

how does cetuximab work?

Answer 19

decreases production of EGFR by binding it on both normal and tumor cells. inhibits the binding of EGF and other ligands. it inhibits the phosphorylation of kinases

Question 20

ipilimumab blocks what?

pembrolizumab blocks what?

nivolumab?

Answer 20

ipilimumab: CTLA-4

pembrolizumab (keytruda): PD1

nivolumab: PD1

Question 21

screening for HNPCC

Answer 21

colonoscopies every 1-3 years starting age 20-25

annual transvaginal ultrasound starting 20-25

Question 22

undescended testicle
- risk of testicular cancer compared to normal population?

• is the contralateral normal testicle also at risk for developing cancer?
• risk of cancer in undescended tesis in the abdomen vs. inguinal canal?
• most common type of cancer in testicle after orchiopexy vs. unrepaired undescended?
• does earlier orchiopexy reduce risk?

Answer 22

• about 2-8 times more
• contralateral testes is not at increased risk
• if in the abdomen, 4-5x higher risk than inguinal
• uncorrected undescended testis: seminoma
• after orchiopexy: non-seminoma
• yes, preadolescent repair results in decreased risk of cancer

Question 23

most common tumor found in meckel??

Answer 23

carcinoid

Question 24

hernia repair.

this nerve lies superiorly in the canal and passes through the external oblique aponeurosis superior to the external ring

this nerve travels beneath the inguinal ligament and does not enter the inguinal canal

this nerve runs within the spermatic cord and supplies the cremaster muscle

Answer 24

iliohypogastric nerve lies superiorly in the canal and passes through the external oblique aponeurosis superior to the external ring

femoral branch of the genitofemoral nerve travels beneath the inguinal ligament and does not enter the inguinal canal

genital branch of the genitofemoral nerve runs within the spermatic cord and supplies the cremaster muscle

Question 25

what is Amyand hernia what is Littre hernia

Answer 25

Amyand: Appendix Littre: Meckel diverticulum

Question 26

peds. gasless abdomen. procedure of choice? what are the TE fistula types

Answer 26

gasless abdomen means long gap esophageal atresia. needs G-tube to let kid grow over time (type A or type B) ``` type A: atresia. no fistula type B: atresia. proximal fistula type C: atresia, distal fistula type D: both proximal and distal fistula type H: H ```

Question 27

liver CT: enhancement of the lesion on arterial phase followed by washout on delayed phase

Answer 27

delayed washout is pathognomonic for HCC. Hepatic adenomas have a variable CT appearance that overlaps with that of HCC, because both lesions enhance on arterial phase. However, hepatic adenomas do not typically demonstrate delayed washout.

Question 28

esophageal CA found on endoscopy. best way to assess locoregional disease? PET CT or MRI?

Answer 28

PET CT of the chest

Question 29

should mesh be used for large hiatal hernia repairs?

Answer 29

short term outcomes are better but it doesn't matter long term based on 3 different RCTs

Question 30

normal esopahgus is lined by what type of epithelium? normal stomach is lined by what epithelium?

Answer 30

stratified squamous epitheliu stomach is lined by simple columnar epithelium

Question 31

most common anterior mediastinum tumor? middle? posterior?

Answer 31

anterior: thymoma. myasthesnia gravis middle: lymphoma posterior: neurogenic tumors

Question 32

pt with Zenker's diverticulum has cervical stenosis and can't extend neck. treatment option? when is it okay to do myotomy alone vs. diverticulectomy?

Answer 32

can't do endoscopy because can't extend neck straight up open diverticulectomy with myotomy >5cm definitely do diverticulectomy <2cm myotomy alone may be sufficient

Question 33

medication protective against radiation enteritis?

Answer 33

ACE inhibitors

Question 34

pt with billroth II has diarrhea, oily stools, malnutrition due to bacterial overgrowth. what kind of diet helps? what kind of anemia? what test can diagnose bacterial overgrowth? treatment?

Answer 34

Medium-chain triglyceride diets Pernicious anemia (vitamin B12 deficiency) is common d-xylose test (carbohydrate breath test) . Metabolism of carbohydrate substrates from bacteria leads to the production of hydrogen and/or methane, which is detected in the breath. treatment: rifaximin, 14 days

Question 35

for surveillance after distal gastrectomy for cancer, what do you do? EGD every 6 months for the first 2 years then yearly for up to 5 years? CTCAP every 6 months for the first 2 years then yearly for up to 5 years?

Answer 35

CTCAP every 6 months for the first 2 years then yearly for up to 5 years

Question 36

a girl swallows a nickel coin. when do you need to do EGD to get it out? can she go home?

Answer 36

if no signs of obstruction she can go home. endoscopic retrieval should be performed if the coin remains in the gastric lumen for more than 3 to 4 weeks.

Question 37

GIST who needs neoadjuvant imatinib? for adjuvant gleevec how long to treat? 1 year? 3 years?

Answer 37

>5cm or >5 mitoses for high risk GIST, treat for >3 years

Question 38

what is amifostine? what is misopristol? what is mifepristone?

Answer 38

Amifostine is a radioprotectant that, when converted to its active form, binds free radicals to prevent cellular damage. dont' use this first for radiation enteritis misopristol is a synthetic prostaglandin E analogue. It can prevent stomach ulcers caused by anti-inflammatories mifepristone is a progesterone blocker used to end pregnancy up to 10 weeks. can also control high blood sugar in patients with Cushing syndrome who have type 2 diabetes and have failed surgery or are not candidates for surgery

Question 39

does highly selective vagotomy cut posterior nerve of Latarjet? does selective vagotomy cut Latarjet? what happens to liquid phase gastric emptying after truncal vagotomy vs. highly selective?

Answer 39

highly selective: no it preserves Latarjet, both posterior and anterior. no need for drainage procedure. it does cut the criminal nerve of grassi (posterior) Selective: yes it cuts anterior and posterior latarjet nerves. Denervates pylorus. Needs drainage procedure truncal vagotomy accelerates liquid phase gastric emptying

Question 40

what do chief cells secrete? what do parietal cells secrete? intrinsic factor is secreted by what? antrum procuces what?

Answer 40

chief cells: pepsin parietal cells: acid, intrinsic factor antrum makes mucous and gastric (from g cells)

Question 41

which is more common after ileostomy reversal? SBO or SSI? when you're doing an ileostomy reversal through the peri-ostomy incision, you encounter an intra-abdominal abscess adjacent to the ostomy site. what do you do?

Answer 41

SBO is more common. 7% if abscess encountered, leave the ostomy in place and drain the abscess operatively. if reversed, risk of leak, fistula at the closure site

Question 42

Which of the following primary neoplasms of the small intestine has the best long-term prognosis? A. Lymphoma of the terminal ileum B. Neuroendocrine tumor (NET) of the ileum with regional lymph node metastases C. Adenocarcinoma of the duodenum D. Gastrointestinal stromal tumor (GIST) of the jejunum measuring 8 cm and with a high mitotic rate E. NET of the duodenum with regional lymph node metastases

Answer 42

Neuroendocrine tumors (NETs) of the duodenum are rare tumors. Even in the presence of regional lymph node metastases and even when treated with simple endoscopic excision as opposed to radical surgical resection, they exhibit an excellent prognosis (100% disease-specific survival) Primary lymphomas of the small bowel have a 5-year survival rate of approximately 50% to 60% Although patients with NETs of the ileum with regional lymph node (and even liver) metastases can live for many years because of the often indolent biology of these tumors, the 5-year survival of such patients is still only on the order of 60% to 70% Adenocarcinomas of the duodenum exhibit the best prognosis of all small bowel adenocarcinomas (likely because of the fact that they tend to be diagnosed at an earlier stage), but the 5-year survival of these tumors is only on the order of 50% Despite the existence of highly effective targeted therapies (tyrosine kinase inhibitors such as imatinib and sunitinib) for gastrointestinal stromal tumors (GISTs), this is a very high-risk GIST; it is large, arises from the small bowel, and has a high mitotic rate. As such, even if this tumor has a favorable mutation in the c-kit gene and thus is responsive to tyrosine kinase inhibitor therapy, the 5-year survival of this patient is unlikely to exceed 80%.

Question 43

what is an abnormal gastric emptying study? what % of radiotracer remaining in the stomach at 2hr vs. 4 hr?

Answer 43

2hr: if >60% remains 4hr: if >10% remains

Question 44

what's the difference between afferent loop syndrome vs. blind loop syndrome? between antecolic and retrocolic Billroth II which one has a higher incidence of blind loop syndrome? what is efferent loop syndrome?

Answer 44

afferent loop syndrome: severe postprandial pain, nonbilious vomiting. it's due to afferent loop obstruction in patients who underwent gastric bypass blind loop syndrome: bacterial overgrowth, chronic malnutrition, B12 deficiency. treat with medium chain triglyceride diet. no abx Antecolic Billroth II is the worst. Retrocolic is preferred. efferent loop syndrome is gastric outlet obstruction due to hernia or kinking. usually within 1st month post-op

Question 45

what length of stricture is classified as: short segment medium segment long segment and which strictureplasty do you use? what do you do for Crohn's stricture of isolated 2cm?

Answer 45

short segment: 5-7cm Heinecke-Mikulicz medium segment: 10-15cm Finney long segment: >15cm Michelassi 2cm is too short and suspicious. do resection to r/o maglinancy

Question 46

What agent has been shown to significantly decrease the severity of nausea and vomiting and patient discomfort in patients with MBO?

Answer 46

octreotide

Question 47

when do they need repeat endoscopy? - pt with mallory weiss tear, now better and recovered, ready to be discharge - gastric cancer pt s/p distal gastrectomy - after complete healing of caustic ingestion

Answer 47

- mallory weiss: no follow-up endoscopy needed - gastric cancer pts need surveillance CTs, not endoscopy - caustic ingestion: 15 years after injury (malignant transformation takes about a decade)

Question 48

for GIST: difference between stage IA vs. IB what makes stage II? IIIA vs. IIIB? GIST has (+) lymph nodes. what stage is it?

Answer 48

IA: <5cm, low mitotic rate IB: 5-10cm, low mitotic rate II: <5cm + high mitotic rate >10cm + low mitotic rate IIIA: 5-10cm, high mitotic rate IIIB: >10cm, high mitotic rate Stage IV tumors are those of any size with either lymph node metastasis or distant metastasis, or both. any positive nodes: stage IV

Question 49

use of GLP-1 analogue (exenatide) vs. GLP-2 analogue (teduglutide)

Answer 49

GLP-1 (exenatide): management of hyperglycemia in diabetics GLP-2 (teduglutide): management of short bowel

Question 50

blood supply for: - cervical esophagus - thoracic esophagus - abdominal esophagus

Answer 50

- cervical: inferior thyroid - thoracic: bronchial arteries + directly from aorta - abdominal: left gastric + inferior phrenic

Question 51

PNET that is - usually in the pancreatic tail - usually in the pancreatic head which type is most common in MEN1? most common PNET in general?

Answer 51

tail: glucagonoma, VIPoma head: somatostatinoma most common in MEN1: gastrinoma most common in general: insulinoma

Question 52

Perforated appendix with abscess - failure rate of non-op management - complication rate of interval appendectomy - risk of recurrent appendicitis - in pts > 40 what needs to be done after initial mngmt? For what reason? - What is the incidence of appendiceal tumor in ALL pts with appendicitis? - what are the odds of concurrent malignancy in pts >40 for UNCOMPLICATED appendicitis, - readmission rate? - length of hospital stay? - complication rate/pain duration? - cost?

Answer 52

- failure rate of non-op management: ~5% - complication rate of interval appendectomy: 2-23% - risk of recurrent appendicitis: ~8% - in pts > 40 Colonoscopy needs to be done after initial management. To rule out malignancy - in ALL pts with appendicitis, tumor rate is ~2% - 15% concurrent malignancy for uncomplicated appendicitis - readmission rate is higher in conservative management (up to 1/3 recur) - longer stay for non-op management - no difference in complication rate/pain duration - higher cost with surgery

Question 53

rivaroxaban apixaban dabigatran

Answer 53

Pra(DA)xa: (DA)bigatran. (D)irect thrombin inhibitor i(DA)rucimab (praxbind) or dialysis Eliquis: apixaban. Xa inhibitor PCC least renal clearance (use in renal pts) Xarelto: rivaroxiban. Xa inhibitor PCC

Question 54

TEG numbers LY30 > 3% alpha angle < 53 R time > 10 amplitutde < 50

Answer 54

LY30: TXA angle: fibrinogen amplitude: platelet time: FFP

Question 55

Where is the dissection plane for carotid endarterectomy to remove the plaque? What layers of the artery are left behind after the endarterectomy? Should you extend your arteriotomy to external carotid to remove residual plaque? Acceptable stroke rate?

Answer 55

Between intima and media. Deep layers of the media and adventitia are left behind to prevent aneurysm Don't extend arteriotomy to external carotid. Complicated patch <6% is acceptable stroke rate

Question 56

management of symptomatic pancreatic pseudocyst: - pseudocyst in communication with the main pancreatic duct and with otherwise normal pancreatic duct anatomy - pseudocyst without communication to the pancreatic duct - if cyst well adherent to the posterior stomach or duodenum - if not adhered to posterior stomach wall or duodenum - tail of the pancreas

Answer 56

- ERCP guided sphincterotomy, or transpapillary stent - endoscopic cystgastrostomy - cystgastrostomy or cystduodenostomy - open/lap roux-en-y cystenterostomy - tail: distal panc may be better

Question 57

only approved systemic therapy for metastatic PNET?

Answer 57

streptozocin resect both primary and liver met if possible can use somatostatin for glucagonoma

Question 58

insulinoma: when is enucleation not okay

Answer 58

>2cm or close to main duct (then needs radical resection) if multiple AND <2cm, enucleate each

Question 59

what % of remaining liver do you need in healthy person? cirrhotic? when to do portal vein embolization?

Answer 59

healthy: needs 20% cirrhotic: needs 40% do portal vein embolization for FLR < 25%

Question 60

trauma pt. retained hemothorax after chest tube. next step?

Answer 60

get a CT first. don't place another chest tube. then will likely need VATS

Question 61

when to start aspirin after splenectomy who gets prophylactic daily augmentin

Answer 61

plt > 1000 x10^6 children <10 for 6 months after splenectomy to prevent OPSI plt 600k can be watched

Question 62

gallbladder polyp is most likely to be what kind? risk factors for malignancy?

Answer 62

cholesterol polyp risk factor for malignancy: stones are also present, >1cm, sessile

Question 63

breast cancer s/p lumphectomy. years later local recurrence. treatment? breast cancer s/p mastectomy. years lateral local recurrence. treatment?

Answer 63

lumpectomy: salvage modified radical mastectomy mastectomy: mammogram, CT, LFT, brain MRI resect with 1cm margin salvage chemo xrt

Question 64

hernias and PD catheters?

Answer 64

fix hernias before if possible but concomitant repair is okay

Question 65

postpartum thyroiditis. when does it happen what antibodies do they have?

Answer 65

4-8 months after delivery and may last up to 9 –12 months anti-thyroid antibodies (anti-thyroid peroxidase, anti-thyroglobulin) Most women will regain normal thyroid function within 12-18 months after the onset of symptoms. However, approximately 20% of those that go into a hypothyroid phase will remain hypothyroid.

Question 66

in hepatorenal, what's the serum sodium level? urine osm? urine sodium? median survival for type I vs. type II?

Answer 66

in hepatorenal they keep absorbing sodium. this pulls more water in than sodium, resulting in hyponatremia. so serum sodium will be low (only because there's more water than sodium) low urine sodium urine osm is higher than serum type I: 2 weeks type II: 6 months

Question 67

how to treat auto-peep

Answer 67

decrease the respiratory rate decrease the I:E ratio (more expiration time, less inspiration time) decrease the tidal volume

Question 68

absent vas defereans

Answer 68

chloride sweat test. CF

Question 69

UC flare. biopsy shows active UC, atypia and mild dysplasia. next step?

Answer 69

medical treatment + repeat colonoscopy/biopsy surgery would be indicated if the patient fails to respond to medical therapy, or if high-grade dysplasia is seen on the repeat colonoscopy with biopsy

Question 70

criteria for adjuvant therapy after colon cancer resection?

Answer 70

anything > T3 any node any met

Question 71

what diameter defines "toxic megacolon" for cecum and colon

Answer 71

cecum: 12cm colon: 6cm

Question 72

pt with locally advanced anal SCC has complete response to nigro. what should the surveillance be? what if there is evidence of persistent disease?

Answer 72

CTCAP or PET annually for the first 3 years if persistent disease, restage with PET + salvage APR

Question 73

surveillance guideline for FAP

Answer 73

start annual colonoscopy at age 10-12 then colectomy when polyp burden > 20

Question 74

rectal cancer MRI vs. US

Answer 74

MRI can define the extent of involvement of the mesorectal fascia, whereas ERUS does not US is better at: - T staging (but it gets worse with higher T stages). especially accurate for T0, T1 - ruling out nodal involvement than diagnosing it

Question 75

GI bleed. planning for colonoscopy. what's the time frame that this needs to be done? <12 hrs? <24 hrs?

Answer 75

Within 24 hours, if bowel "prep" yields clear, liquid stool Several studies have compared urgent (< 8 or 12 hours from presentation) colonoscopy versus elective colonoscopy (24-90 hours from presentation). In patients who are hemodynamically stable without ongoing transfusion requirement, urgent colonoscopy did not result in reduced mortality but did shorten length of stay and time to hemostasis

Question 76

what type of study? get people with disease and try to find what they were exposed to will this study measure odds ratio or relative risk?

Answer 76

case control risk cannot be determined in a case-control study. Odds ratio is what you get odds of the disease given an exposure divided by the odds of the disease given no exposure

Question 77

what is an intention to treat analysis?

Answer 77

in a randomized controlled trial ignores noncompliance, withdrawal, and crossover and therefore produces a conservative estimate of the effect of the treatment on the outcome

Question 78

what analysis do you need to use for survival analysis?

Answer 78

Cox proportional hazard analysis

Question 79

what type of study can report relative risk?

Answer 79

cohort study and randomized clinical trials can both report relative risk.

Question 80

what type of study is cohort study in terms of exposure and disease?

Answer 80

find everyone who had the EXPOSURE then see if they got the disease or not. you can get relative risk from this case control study is when you find everyone who has the DISEASE and then try to look at their exposure

Question 81

what's the difference between linear regression vs. logistic regression?

Answer 81

linear regression: comparing how multiple variables are associated with a CONTINUOUS variable logistic regression: comparing how multiple variables are associated with a CATEGORICAL variable