SURGERY Flashcards
(551 cards)
1
Q
Phases of wound healing
A
Phase I - Hemostasos and Inflammation
Phase II - Proliferation
Phase III - Maturation and Remodeling
2
Q
First infiltrating cells to enter wound site
A
Polymorphonucleic acid/ neutrophils
“NAUNA”
3
Q
2nd population of inflammatory cells that invades the wound
Remain present until the wound healing is complete
A
Macrophage
“Matagal mawala”
“Maestro”
4
Q
Bridge between phase I and II
Peaks about 1 week lost injury
A
T lymphocyte
“Tulay”
5
Q
Arrival of fibroblast and endothelial cells
A
Proliferation phase
6
Q
Last cells to infiltrate the healing wound
A
Fobroblast and endothelial cells
7
Q
Stronges chemotactic factor for fibroblasts matrix synthesis
A
PDGF
Platelet derived growth factor
8
Q
Matrix component
A
Type III collagen (early matrix)
Proteoglycan
Type I collage (final matrix)
9
Q
Most abundant protein in the body
A
Collagen
10
Q
Clean wound
A
Primary intention
Suture the wound
11
Q
Dirty wound
A
Let the tissue degranulate itself
No suture
12
Q
Elective colon resection
A
Clean contaminated
Bowel prep
Enema
Clean bowel
13
Q
Major cell responsible for contraction
A
Myofibroblasts
14
Q
Can stimulate epithelialization of wound that was affected by steroid delayed healing
A
Vit A
15
Q
Dilute sodium hypochlorite used in contaminated wounds
A
Dakin’s solution
16
Q
Amino acid that is most active in terms of wound fibroplasia
A
Arginine
17
Q
Vitamin deficiency leads t failure of collagen synthesis and cross linking
A
Vit C
18
Q
Epithelialization of a sutured wound
A
24 to 48 hrs
19
Q
Stays within confines of original wound
A
Hypertrophic scar
20
Q
Keloid
A
extends beyond confines of original wound
21
Q
Malignant transformation of chronic wound
A
Marjolin ulcers
22
Q
Most common trauma ressucitation fluid
A
Plain LR
23
Q
Treatment of hyperkalemia
A
Calcium gluconate
Bicarbonate
Insulin
Glucose
Kayexalate
24
Q
High peaked T waves
Widened QRS
Ventricular fibrillation
A
Hyperkalemia
25
U wave
T wave flattening
Hypokalemia
26
Nyhus type IIIA
Direct hernia
27
Most common groin hernia on bothe men and women
Indirect ingunal hernia
28
Femoral hernia is common in what population
Female
29
Nyhus Type IIIC
Femoral hernia
30
Hesselbach's triangle
Superior : Inferioir Epigastric
Inferior: Inguinal Ligament
Medial: Lateral edge of rectus sheath
"Hassle = IE IL LR (E L R) "
31
Hernia where it protrudes MEDIAL to the inferior epigastric vessels, within Hesselbach's triangle
Direct hernia
32
Hernia where it protrudes LATERAL to the inferior epigastric vessels through the deep inguinal ring, lateral to Hesselbach's triangle
Indirect hernia
33
Hernia protrudes BELOW inguinal canal between the femoral vein and lymphatic channels
Femoral hernias
34
Space between peritoneum and the posterior lamina of the transversalis fascia
Contains peritoneal fat
Space of Bogros
35
Most media area of the space of bogros lying superior to the bladder
Retzius space
36
Spacw between anterior and poaterior laminar of the transversalis fascia
Contains Inferior Epigastric Vessels
Vascular space
37
Triangle of Pain borders
IlioPubic tract
Gonadal vessels
"PIG"
38
Triangle of Doom borders
Ductus deferens - medial
Gonadal vessels
Doom = "DuGo"
39
Triangle of Doom contents
Deep circumflex iliac vein
External iliac vessels
Femoral nerve
Genital branch of genitofemoral nerve
"Content: cDEFG"
40
Circle of Death
Common Iliac
Internal Iliac
External Iliac
Obturator
Inferior Epigastric
41
Tissue repair high tension and high recurrence rates
Triple layer repair: Internal oblique, transversus abdominis and transversalis fascia foxed to the inguinal ligament and pubic periosteum in simple interrupted sutures
Bassini repair
42
Moat commonly used tissue repair
Routine division of the genital branch of the genitofemoral nerve
Less recurrence, less tension
Shouldice repair
43
Tissue repair in both inguinal and femoral hernia
Fixes the superior flap to the COOPER'S LIGAMENT continuing it laterally to occlude the femoral ring
Relaxing incision on the anterior rectus sheath
McVay repair
44
Mesh free repair which utilizes the external oblique aponeurosis
Desarda repair
45
Most commonly performed ingubal hernia repair
Tension free and buttresses the inguinal floor with prosthetic mesh
Lichtenstein technique
46
Laparoscopic approach for bilatwral hernia
Higher risk of intraabdominal injuries
Transabdominal Preperitoneal Repair (TAP)
47
Peritoneum is not incised but instead a mesh is placed directly over the defect and fixed in place by tacks
Used if TEP and TAP unfeasible
Intraperitoneal Onlay Mesh Repair (IPOM)
48
1-2 cm midline neck mass that moves upward with protrusion of the tongue
8th week persistence
Thyroglossal duct cyst
49
Recurrent Laryngeal nerve innervates ALL laryngeal muscles EXCEPT
Cricothyroid
50
RLN that has more oblique course
Left or right?
Right
= harder to find
51
Nerve that supplies the CRICOTHYROID
Superior Laryngeal Nerve
52
Injury yo the external branch of Superior Laryngeal Nerve will cause...
Difficulty hitting high notes and voice fatigue
53
Marker for Medullary thyroid cancer
Serum calcitonin
54
Positive prehn sign means?
+ prehn sign = relief from pain when lifting the testicle
= epididymitis
(-) prehn sign = no relief = testicular torsion
55
Most common type of lipid profile associated with pancreatitis
Type 5 (increased triglycerides)
56
Antibiotics given to patients with severe pancreatitis
imipinem
57
Most common variants in origin of hepatic arteries
right hepatic - off SMA, 20%
left hepatic - off LEFT GASTRIC, 10%
58
Structures in portal triad
Portal Vein - Posterior
CBD - on the Right anteriorly
Hepatic Artery - on Left anteriorly
59
bacteria most common agents of biliary sepsis
E. coli and Klebsiella
60
triad of hematobilia
GI bleed
Jaundice
RUQ pain
61
CHarcot's triad ---- CHolangitis
Fever (w/ chills)
Jaundice
RUQ tenderness (biliary colic)
62
Reynod's pentad
Fever
Jaundice
RUQ tenderness
HYPO tension
Mental status change
63
Most common cause of biliary stricture
Iatrogenic injury (lap chole)
64
most common cause of cholangitis after choledocoduodenostomy or choledochojejunostomy
anastomotic stricture
65
a large gallstone in the NECK of the gallbladder, compressing the COMMON BILE DUCT and inducing biliary obstruction
Mirizi syndrome
Type 1 - obstruction only
Type 2 - cholecystic-biliary fistula
66
5 types of choledochal cysts
Type 1 (most common) - Fusiform extrahepatic (tx - resection and hepaticojejunostomy)
Type 2 - diverticulum of CBD
Type 3 - periampullary
Type 4 - intra and extrahepatic
Type 5 - intrahepatic
67
Rule of 10 for Insulinomas
10% slitary
10% malignant
10% associated with MEN
10% ectopic
68
Risk factors for Budd-Chiari syndrome (hepatic vein thrombosis)
Hypercoaguable conditions (pregnancy, factor 5 leiden mutation, hepatitis, liver abscess, polycythemia, malignancy and other inheritable conditions)
69
most common presentation of Budd-chiari syndrome
Hypercoaguable patient who presents with ascites and abdominal distention
70
treatment option of Budd-chiari syndrome
Vena cava present and hepatic function salvageable ---> portosystemic shunt
Partial hepatic venous thrombosis present ---> thrombolysis and stenting
Fulminant hepatic failure ---> transplant
71
Unknown etiology with multiple dilatations and strictures of intra- and extrahepatic biliary ducts (beading)
Primary sclerosing cholangitis
72
most common site of obstruction in gallstone ileus
Terminal ileum
Classic presentation:
- Air in biliary tract
- SBO
73
most common cause of amoebic liver abscess?
tx?
Entamoeba histolytica
Metronidazole
74
Normal pancreatic anatomy in oatients with pancreatic divisum
NL - Santorini = small; Wirsung = major
Divisum - Santorini = major duct
Divisum occurs in 5% pop and is an embryonic failure of fusion of ducts
--prone to pancreatitis
75
gene mutated in 90% of pancreatic cancer patients
K-Ras
76
Most common islet cell tumor
Insulinoma
77
Surgical tx of Insulinoma
Enucleation
78
Deficiency of these coagulation inhibitors in patients with liver disease may lead to thrombotic states
antithrombin III
Protein C
Protein S
79
true or false
Regional anesthesia is contraindicated with patients with coagulopathy
True
80
Drugs effective if spasm of the sphinctr of Oddi is suspected
Atropine
Glucagon
Nalaxone
Nitroglygerin
81
Gallstone associated with cirrhosis and hemolysis
Black-pigment stones (bilirubin)
82
how to confirm diagnosis of amebic abscess?
By indirect hemagglutination
83
Pathological features of hepatocellular carcinoma (HCC) are associated improved survival
tumors exhibiting the FIBROLAMELLAR variant, ENCAPSULATED tumor, and PEDUNCULATED tumors
84
an operation for bleeding esophageal varices in which division of the esophageal varices is accomplished by TRANSECTION of ESOPHAGUS and REANASTOMOSIS, usually with an EEA stapler
Sigura procedure
85
proper treatment for bleeding gastric varices without esophageal varices
splenectomy for splenic vein thrombosis
86
most common cause of portal hypertension in children
portal vein thrombosis
87
what pressure defines portal hypertension
12mmHg
88
Substances thought to be responsible for the hyperdynamic circulation seen in patients with cirrhosis and portal hypertension
Prostaglandins
Glucagon
Nitric oxide
TNF
89
90
Laboratory findings in a patient with Idiopathic Thrombocytopenia Purpura (ITP)
Platelet count less than 50,000/mm³
Prolonged bleeding time
Normal clotting time
91
Treatment for ITP
Initial 6 weeks to 6 months trial of steroids
If there is no response to steroid therapy, splenectomy is indicated
92
Mechanism of portal hypertension caused by schistosomiasis
Presinusoidal obstruction
93
30yo female
Acute onset fever and purpura
Anemia
Thrombocytopenia
Leukocytosis
Elevated BUN and creatinine
Dx?
Thrombotic Thrombocytopenic Purpura (TTP)
94
Characteristic blood smear in postsplenectomy patient
Howell-Jolly bodies
Siderocytes
Leukocytosis
Increased platelet count
95
Most common cause of spontaneous splenic rupture
Complications of malaria and mononucleosis
96
Appropriate management for patients with portal vein injury that cannot be repaired
Ligation of the portal vein
97
Most common cause of secondary hypersplenism
Hepatic disease or extrahepatic portal vein obstruction
98
Clinical manifestation of pancreatic exocrine insufficiency
Steatorrhea and malabsorption
99
Clinical course of sclerosing cholangitis
Chronic, relapsing disease associated with jaundice, pruritis, pain and fatigue
100
Flank ecchymosis
Represents dissection of blood from the retroperitoneum near the pancreas in patients with hemorrhagic pancreatitis
Gray Turner's syndrome/sign
101
Serum amylase of patient with acute pancreatitis
2 to 5 times normal
102
Most common finding on plain abdominal xray in patient with acute pancreatitis
Dilatation of an isolated loop of intestine adjacent to the pancreas (sentinel loop)
103
Principal symptom in majority of patients with chronic pancreatitis
Abdominal pain (epigastrium), cramping, boring or aching
104
Most common complication of chronic pancreatitis
Pseudocyst, DM and malnutrition
105
Most common islet cell tumor in MEN-1
Gastrinoma
106
Most common location of gastrinoma
Gastrinoma triangle
- cystic/CBD junction
- pancreas neck
- third portion duodenum
107
Medical conditions associated with somatostinoma
Gallstones
Steatorrhea
Pancreatitis
Diabetes
108
Syndrome associated with Vasoactive Intestinal Polypeptide (VIP)oma
WDHA syndrome
Watery Diarrhea
HypoKalemia
Achlorhydia
109
Lateral pancreaticojejunostomy
Puestow procedure
Perfor thus procedure if >7mm diameter of main pancreatic duct
110
What is meant by modified whipple?
Preservation of the stomach and pylorus
111
Most common benign neoplasm of the exocrine pancreas
Serous (microcystic) cystadenomas
112
If the patient has a serum gastrin level of 200 to 500 pg/mL, what test must be done to confirm the diagnosis of gastrinoma?
Secretin provocative test
113
DOC for treatment of gastrinoma
Omeprazole
114
Cause of most cases of WDHA
Islet Cell Tumor of the pancreas that produces VIP
115
Conditions associated with Annular pancreas
Down's syndrome
Duodenal atresia
Peptic ulcer
116
Most common type of biliary enteric fistula
Cholecystoduodenal
117
Most common clinical manifestation of decompensation in a cirrhotic patient?
Ascites
118
Most common benign hepatic tumor
Cavernous hemangioma
119
(+) kupffer cells
What benign hepatic lesion?
FNH
120
Multiple thin adhesions ("violin string adhesion") seen in the RUQ to the surface of liver and surrounding fundus of the gallbladder
Fitz-Hugh-curtis syndrome
-intraabdominal dissemination of pelvic inflammatory disease (PID)
121
Name of cholangiocarcinoma that presents at the confluence of the right and left hepatic ducts
Klatskin tumor
122
Pathognomonic finding for chronic pancreatitis on KUB
Pancreatic calcifications
123
Most specific and sensitive test for diagnosis of chronic pancreatitis
ERCP
124
Endoscopic finding hallmark of Zollinger-Ellsion syndrome
Peptic ulcerations in an unusual site, including postbulbar and JEJUNAL ulcerations
125
Where are primary bile salts converted to secondary bile salts?
Small intestine
126
How is caudate lobe different from the other segments of the liver, with respect to its vascular supply?
Receives blood from L and R hepatic arteries and portal vein. Most venous blood drains directly into the vena cava
127
Risk factors of HCC
Aflatoxins
Low protein intake
Hepatitis B and C
Cirrhosis
128
What organisms produce hydatid cysts of the liver
Echinococcus granulosus and echinococcus multilocularis
Tx: enucleation and avoid spilling the cyst as it may cause anaphylaxis
129
Drug that reduces the risk of rebleeding after a first bleed by decreasing the portal pressure of patients with bleeding esophageal varices
Propranolol
130
Arterial supply shared by head of pancreas and 2nd and 3rd portions of the duodenum
Inferior pancreaticoduodenal artery, from superior mesenteric artery, collaterizes with superior pancreaticoduodenal artery, arising from gastroduodenal artery
131
The only pancreatic enzyme secreted in active form
Amylase
132
Vessels contained within the GastroSplenic ligament
ShortGastrics
133
Primary pathophysio in acalculous cholecystitis
Gallbladder stasis
134
Anemia
Reticulocytosis
Jaundice
Splenomegaly
Hereditary spherocytosis
135
Splenomagaly
Anemia
Neutropenia
Thrombocytopenia
Arthritis (rheumatoid)
Felty syndrome
"SANTA"
136
Indication of splenectomy in patient with Felty syndrome
Recurrent infections with neutropenia
Patient requiring transfusion for anemia
Profound thrombocytopenia
Intractable leg ulcers
137
Main chemical component of pigment gallstone
Calcium bilirubinate
138
IV drug user
Fever with chills
Splenomegaly
LUQ abdominal tenderness
Dx?
Splenic abscess
Tx: splenectomy
139
Principal anions in pancreatic juice
Bicarbonate
Chloride
140
Structure at the posterior of portal vein and superior mesenteric vessels
Uncinate process of pancreas
141
Cells synthesize somatostatin
Delta cells
142
Abnormal rotation and fusion of Ventral pancreatic primordium
Annular pancreas
143
Significance of the colon cutoff sign
Caused by inflammation of pancreas, which induces spasm in the adjacent colon
144
Region of the pancreas where most pseudocyst occur
Body of pancreas
145
Classic diagnostic (Whipple's) triad for insulinoma
Hypoglycemic symptoms produced by fasting glucose less than 50mg/dL during symptomatic episodes and relief of symptoms with IV administration of glucose
146
Distended and palpable gallbladder in a jaundiced patient
Suggests malignant obstruction
Courvoisier's sign
147
Organs included in Whipple procedure
Distal stomach
Gallbladder
Common bile duct
Head of pancreas
Duodenum
Proximal jejunum
Regional lymphatics
148
Etiology of Zollinger ellison syndrome
Gastric acid hypersecretion caused by excessive gastrin production
149
How many molecules of ATP does glycolysis generate for each molecule of glucose?
37, with one molecule being utilized for storage
150
Landmarks that demarcates right hepatic lobe from left hepatic lobe
Gallbladder fossa and IVC
151
Manomerty : Failure of Lower esophageal sphincter (LES) to relax completely, with swallowing associated with an absence of organized propulsive peristalsis, and nonpropulsive simultaneous contractions (tertiary waves) on manometry
Achalasia
152
Most common complain of patient with duodenal ulcer
Epigastric pain
153
Esophagogastroduodenoscopy (EGD) : bird beak esophagus is the classic UGI finding. The gastroesophageal (GE) junction should not appear strictured unless its end stage case
Achalasia
154
What does parietal cell secrete?
HCL and Intrinsic factor
155
what does intrinsic factor assist in?
binds to B12 and allows B12 absorption in Terminal Ileum
156
2 layers plicating sutures placed between the gastric fundus and the lower esophagus with subsequent creation of a 280-deg anterior gastric wrap and posterior approximation of the crura
Belsey procedure
157
best test to dx GERD
24 hr pH probe
158
Chief cells produce?
Pepsinogen
- initiates gastric proteolysis
159
Peptide activates the digestive cascade
Enterokinase - acts on Trypsinogen to Trypsin
160
Tx for achalasia
1. Endoscopic dilation or botulinum injection
2. Esophagomyotomy - HELLER MYOTOMY
3. Total esophagectomy
161
presence of 2 to 3 cm of columnar intestinal epithelium along the esophageal mucosa
Barrett's esophagus
= intestinal metaplasia
162
highly selective vagotomy is
division of individual branches of the nerve of Latarjet, preserving the crow's foot
163
classic metabolic abnormality associated with Gastric Outlet Obstruction
HypOchloremic, hypOkalemic metabOlic acidOsis
164
most common type of gastric polyp
Hyperplastic polyps
165
a proximal branch of Posterior vagus nerve which can be missed during vagotomy and can lead to persistent gastric secretion
criminal nerve of Grassi
166
3 main peptides that stimulate the parietal cell
Acetylcholine
Histamine
Gastrin
------which through calcium, activate protein kinase C, which increases HCl secretion
167
G cell produce?
Gastrin
Located at the antrum of stomach.
Stimulated by amino acids and acetylcystine
Inhibited by acid
168
cell hypeplasia increase in gastrin levels associated with?
Enterochromaffin hyperplasia (precarcinoid lesion)
169
Test for gastrinoma
Secretin stimulation test
170
MOA of omeprzole
blocking of H/K ATPase of parietal cell with a secondary decrease in acid production
171
a dense annular band in the submucosa at squamocolumnar junction
Schatzki's ring
172
Most potent stimulant for gastric acid secretion
high protein meal
173
80yo man
dysphagia
gurgling in neck when swallowing
Zenker's diverticulum
174
Dx test for Zenkers diverticulum
Barium swallow
175
Function of somatostatin
Pan-GI inhibition
Inhibits Gastrin,
Insulin,
Secretin,
Ach
Pancreatic and biliary output
Release is stimulated by ACID in DUOdenum
176
Peptide YY
released in Terminal Ileum and acts to INHibit acid secretion and GI motility
177
Most common malignant neoplasm of esophagus
Adenocarcinoma
178
Tx for Barrett's metplasia
Nissen fundoplication
179
How does erythromycin stimulates GI tract
acts on motilin receptorand is prokinetic
Motilin is the key stimulatory hormone of MMC
180
Where does most water absorption occur?
Jejunum
181
Recommended therapy for PUD in pregnancy
Sucralfate - minimal systemic absorption and acceptable healing rates of 80% in 6 weeks
182
longitudinal incision of pylorus that is closed transversely
Heineke-Mikulize procedure
183
How does GB concentrate bile?
Active reabsorption of Na and Cl with water absorption via osmosis. The bile pool is 5g and is recirculated every 4 hours and we lose 0.5g daily
184
Primary bile acids
cholic and chenodeoxycholic acid
185
Secondary bile acids
deoxycholic acid and lithocholic acid
186
Strongest cell layer in the esophagus
Mucosa
(NO SEROSA IN ESOPHAGUS)
187
type of hiatal hernia always managed surgically
paraesophageal
188
Tx for Zenker's diverticulum
Myotomy and Diverticulectomy
189
most common location for ectopic pancreas
gastric antrum or duodenum
190
most common malignant tumor of duodenum
Adenocarcinoma
191
Atrophic gastritis
Adult onset celiac sprue
Chronic pancreatitis
GI manifestation of Sjogren's syndrome
192
initial procedure for patient with Zollinger-Ellison ayndrome and hypertparathyroidism
Parathyroidectomy
193
Normal components of bile
Bile salts - 80%
Lecithin - 15%
Cholesterol - 5% (increase cholesterol concentration form stones)
194
Frequent simultaneous contractions associated with normal LES function and normal peristaltic contractions
manometric criteria for Diffuse Esophageal Spasm (DES)
195
treatment for intractable GERD in patient with poor esophageal motility
Posterior partial (Toupet) fundoplication
196
Tx for DES
1. Nitrate or calcium channel blocker therapy
2. extended esophageal myotomy
197
Factors make GI fistulas less likely to heal with non operative therapy
Foreign body
Radiation
IBD or Infection
Epithelization
Neoplasm
Distal Obstruction
Sepsis
"FRIENDS"
198
Best surgical approach for resection of a bulky esophageal carcinoma 25cm from incisors
Ivor-Lewis approach (combined laparotomy, right thoracotomy and cervical approach)
199
Most common location of stomach ulcer
Lesser curvature, near incisura angularis (type 1)
200
Cobblestoning of mucosa on EGC with granulomas on biopsy
UGI Crohn's disease
(coexisting lower ileal GI Crohns is almost universal)
201
Most common sarcoma of stomach
Leiomyosarcoma
202
Most common site of esophageal perforation in Boerhaave's syndrome
Left Posterolateral esophagus, 3-5cm above GE junction
203
Submucosal defect overlying an artery in the muscularis
Most common in lesser curvature of stomach
Diulafoy's lesion
204
Decrease in number of ganglion cells in Auerbach plexus
Chaga's disease or Achalasia
205
206
Structures supplied by superior mesenteric artery
Small bowel from liganent of treitz to cecum
Ascending colon
Trabsverse colon
207
Gut hormone released from small bowel mucosa after contact with tryptophan and/or fatty acids and results in secretion of enzymes by pancreatic acinar cells
Cholecystokinin (CCK)
208
Where are bile salts reabsorbed?
Ileum
209
Dense retrosacral fascia that covers the sacrum and overlying vessels and nerves
Waldeyer's fascia
210
Energy source for active sodium transport in the colon
Short chain fatty acids
211
Strongest component of the small bowel wall
Submucosa
212
Hormones inhibit colonic motility
Glucagon and somatostatin
213
Most abundant organism in colon
Bacteroides and E. Coli
214
Region of the colon where volvulus most frequently occur
Sigmoid colon
215
Large dilated loop of colon oriented to the RUQ ("Tire sign")
Bird beak tapering of the distal sigmoid colon
Sigmoid volvulus
216
Colonic diverticula most commonly occur in
Sigmoid colon
217
LLQ abdominal pain may radiate to suprapubic area, left groin or back and alteration in bowel habits (usually constipation)
Symptoms of acute diverticulitis
218
Xray- large, air-filled right colon
83 yo
Severe abdominal distention w/out significant pain or tenderness
Dx?
Ogilvie syndrome
219
Tx for colonic pseudo-obstruction (Ogilvie syndrome)
Colonoscopic decompression and Neostigmine (cholinesterase inhibitor) to increase parasympathetic function
220
Test of choice to confirm diverticulitis
CT scan
221
MC complication of diverticulitis
Fistula and abscess formation
222
Most common cause of massive colonic hemorrhage
Diverticulosis and Angiodysplasia
223
MC site of Angiodysplasia
Cecum and right colon
224
4 primary small bowel cancer and their common site
1. Adenocarcinoma - Proximal
2. Carcinoid tumor - Distal (Ileum and SMA)
3. Lymphoma - Throughout tract
4. Gastrointestinal Stromal tumor (GIST)/ Sarcoma - throughout tract
Tx for all- sx resection
225
Intolerance of gluten (wheat, barley, rye). Results in diarrhea. Increase risk of future GI malignancy particularly small bowel lulymphoma.
Celiac Sprue disease (Gluten enteropathy)
226
Submicosal hemorrhage, edema, and thumb printing of the involved colonic segment
Ischemic colitis
227
Demarcation line of internal from external hemorrhoids
Dentate line
228
Indications for excisional hemorrhoidectomy
1. Large 3rd or 4th degree hemorrhoids cannot be treated in OPD
2. Mixed hemorrhoids w/ external endoderm component amenable to resection
3. Acutely thrombosed or incarcerated w/severe pain and impending gangrene
229
MC location of anal fissures
Posterior midline
230
Antibiotics most frequently implicated in the development of pseudomembranous colitis
Clindamycin (MC!!)
Ampicillin
Cephalosporins
231
Organism associated with pseudomembranous colitis
C. Difficile
232
DOC for C. difficile colitis
IV or oral METRONIDAZOLE or oral Vancomycin (metro contraindicated to pregnant)
233
Most common protozoon that infects the colon
E. histolytica --- cystic form
234
DOC for E. histolytica
Metronidazole
235
Tx of choice for CMV colitis
Gancyclovir
236
Etiology of Chaga's disease
Trypanosoma cruzi
237
Contents of ischiorectal fossa
Inferior rectal vessels and lymphatics
238
Tx of squamous cell CA of anal canal
Nigro protocol: chemo + radiation
Recurrence is treated with abdominiperoneal resection
239
Cancers associated with Lynch II (hereditary nonpolyposis colorectal cancer)
Stomach
Ovary
Bladder
Colonoscopy should start at 20yo. Also screening for uterine and ovarian cancer
Type 1 has no associated increase risk of other malignancies
240
Genetic mutations in Lynch I and II syndromes associated with
DNA mismatch repair gene
241
In tx of fistula in ano, if the anus is transected in transvere fashion, external openings anterior to the incision will connect with an internal opening by a short, direct fistulous tract. Posterior fistilas take a more tortous course
Goodsall's rule
242
Appropriate tx for hidradenitis suppurativa
Wide excision, including the indurated overlying skin
243
Most common cause of perianal pruritis in children
Emterobius vermicularis (pinworm)
244
Etiology of Lymphogranuloma Vebereum (LGV)
Chlamydia trachomatis
245
Multiple, soft lesions that are very PAINFUL and friable
ChancROID!!!
246
Treatment of choice for chancroid
Sulfonamides
247
Layer of the colon affected by ulcerative colitis
Mucosal layer only
248
IBD that has CONTINUOUS distribution in the colon
Ulcerative colitis
249
Treatment for acute Crohn's colitis
IV steroids, flagyl and consideration of 6-MP or azathioprine
Sx if with necrosis
250
Hallmark maintenance medication of Crohn's disease
MESALAMINE (Pentasa)
Sulfasalazine
Methotrexate
251
An anti TNF antibody which decreases steroid requirements in acute bouts of Crohn's disease and aids in closure of perianal fistulas
Infliximab
252
Most frequent site of Crohn's disease
IleoCecal region
253
Linear ulceration
Cobblestoning
Asymmetric involvement
Skip lesions
Apthous ulcers
STRICTURES
Crohn's disease
254
Extraintestinal manifestations associated with FAP
Epidermoid cyst
Dermoid tumors of abdomen (Gardner's syndrome)
Osteomas
Brain tumors (gliomas and medulloblastoma)
255
Mutated gene in FAP
APC tumor-suppressor gene
Autosomal dominant
256
Mutation of Serotonine Threonin Kinase (STK gene)
Autosomal dominant
Associated with diffuse GI hamartomas
Peutz-Jegher's syndrome
257
Diffuse mucocutaneous pigmentation and multiple GI hamartomas
Increased risk of colon, breast, uterine, small intestinal and ovarian adenocarcinomas
Peutz-Jegher's syndrome
258
MC cause of GI bleed in childhood
Meckels diverticulum
259
MC type of adenomatoys colonic polyp
Tubular adenoma
260
Conduit of choice during mesenteric revascularization when simultaneous bowel resection is required
Saphenous vein
261
Cell in the lumen responsible for ANTIGEN UPTAKE and TRANSPORT to underlying lymphoid nodules
M cells
262
Ovarian mass detectable on bimanual pelvic exam which represents a drop metastasis or transcoelomic implantation of the ovary from an intra-abdominal site (stomach)
Krukenberg tumor
263
Tumors of mesodermal (interstitial cells of cajal) origin
Bleeding /GI obstruction
HIsto grade predict clinical outcome
GISTs
264
Oncogene associated with GISTs
C-kit oncogene
265
Adjuvant therapy of choice for GISTs
Imitinab (gleevec)
MAB to the Tyrosine Kinase receptor
266
Elevated level of this chemical compound is associated with malignant CARcinoid syndrome
5-hydroxyindoleacetic acid (5-HIAA) and
Vanillylmandelic acid (VMA)
267
Crohn's disease prone to what type of kidney stones
Oxalate stones
268
Most frequent location for villous adenomas in the small intestine
Duodenum
269
MC source of hematogenously spread malignancy to the small intestine
Malignant melanoma
270
65yo female
Mild abdominal distention
Nausea vomiting
KUB- pneumobilia and paucity of air in colon
Dx?
Gallstone ileus
- fistulous communication between gallbladder and duodenum.
271
MC location of Kaposi's sarcoma
Duodenum
272
Lymphatics of the lower half of abdominal wall drians in to...
Ingunal nodes, then Iliac nodes
273
Most common cause of rectus sheath hematoma
Rupture of Epigastric artery or vein secondary to trauma
274
These are aggressive fibromatosis soft-tissue tumors that lack histological features of malignancy yet can be destructive to the abdominal contents when intra-abdominal.
Desmoid tumors
275
Blood supply of rectus abdominis muscle
Superior and inferior EPIgastric arteries
276
Composition of posterior rectus sheath below linea semicircularis
Transversalis fascia
277
Most common solid omental tumor
Metastatic carcinoma
278
Hernia found deep to external oblique through the linea semilunaris and inferior to the linea semicircularis.
Difficult to diagnose
Spigelian hernia
279
Vessel that runs within the transverse MesoColon
Branches of MIddle Colic artery and accompanying vein
280
MC cause of acute occlusion of SMA
Emboli (from heart)
281
Most frequent visceral artery affected by aneurysm
Splenic artery
282
Blood supply of anterior abdominal wall
Superior and Inferior epiGastric arteries
Lower intercostal arteries
Circumflex Iliac arteries
283
Most frequent site of rupture of appendix
Antimesenteric border
284
MC cause of appendiceal lumen obstruction in children and young adults
Lymphoid hyperplasia from submucosal follicles
285
Elderly woman with SBO
Medial thigh pain
Palpable mass on lateral rectal wall
Dx?
Obturator hernia
286
Systemic disease can cause lymphoid hyperplasia in appendix
Gastroenteritis from Shigella and Salmonella
URTI
Infectious Mono and Measles
287
Borders of Femoral Canal
Superior and Medial - Iliopubic tract
Inferior - Cooper's ligament
Lateral - Femoral vein
288
UTZ - appendix diameter >6mm,
Noncompressibility
Presence of complex mass
UTZ finding in Acute appendicitis
289
MC organisms found in wound infections after appendectomy
Bacteroides
Enterobacter
Klebsiella
E. Coli
"BEKE"
290
MC cause of intestinal obstruction world wide
Hernias
291
Lower edge of posterior rectus sheath, approx 3-6cm below level of umbilicus
Linea semicircularis
292
Curved depression seen lateral to the rectus abdominis
Linea semilunaris (Line of Douglas)
293
Pain on internal rotation of right hip
Obturator sign
294
Hernia, where one of the contents includes 1 side (usually antimesenteric side) of intestinal wall.
This hernia strangulates without any evidence of intestinal obstruction and is easy to miss
Richter's hernia
295
Hernia, part of the wall of the sac consists of a viscus (urinary bladder, cecum etc)
Sliding hernia
296
Triangle of Dooom
Area between the Vas deferens and gonadal vessels seen on laparoscopic approach where, for example, the Iliac vessels are at risk of injury from staples
297
Intraabdominal hernia to the left of SMV creating a closed-loop bowel obstruction
Paraduodenal (Treitz) hernia
298
Hernia sac contains ruptured appendix
Usually mistaken with strangulated hernia
Amyand's hernia
299
Structures derived from external oblique muscle and aponeurosis
Inguinal Ligament
Lacunar ligament
Superficial inguinal ring
300
Inguinal hernia with incarcerated Meckel's diverticulum
Littre's hernia
301
Boundaries of superior lumbar triangle of Grynfelt
Superior - 12th rib
Inferior - internal oblique muscle
Posterior - sacrospinalis muscle
302
Boundaries of inferior triangle of Petit
Posterior - Latissimus dorsi
Anterior - External oblique
Inferior - Iliac crest
303
The relaxing incision in the transversus abdominis, superomedial to the inguinal canal, to relieve tension on the repair
Tanner' slide operation
304
Usual content of epigastric hernia
Preperitoneal fat
305
Pain passing down the inner side of the thigh to the knee in an obturator hernia with internal thigh rotation
Howdhip Romberg sign
306
Primary nutrition source for colon and small bowel
Colon - short chain FA
Small bowel - glutamine
307
During inflammatory phase of wound healing, what chemotactic factors attract neutrophils to the wound
Complement componens C5a and PDGF
308
K/cal contents of carbs/protein/fat
Carbs - 3.4
Protein - 4
Fat - 9
309
Single best measure of nutritional status
Serum albumin level
310
It stimulates growth of fibroblasts and inhibits growth of epithelial cells
It enhances angiogenesis
Transforming Growth Factor-beta (TGF-beta)
311
Where are branched chain amino acids metabolized
Muscle
312
Products of platelet degranulation
TGF-beta and PDGF
313
Child with edema
Variable weight
Hypoalbuminemia
Kwashiorkor (acute visceral protein depletion)
314
Primary cell regulating collagen synthesis
Macrophage
315
Cell secretes PRO-ALPHA COLLAGEN CHAINS
Fibroblasts
316
How is serum protein maintained kn fasting
By hepatic conversion of FA to ketone bodies
317
Dominant cell type during inflammatory phase of wound healing
Macrophage
318
Best measurement of marginal malnutrition
Retinal-binding prealbumin
319
What electrolyte should be inspected if difficulty correcting patient's low Ca
Magnesium
320
Hormone normally regulates protein synthesis and breakdown
Insulin
321
Amino acid, key fuel for rapidly dividing cells, including cancer cells
GLUTamine
322
Stimulates DNA synthesis and cell division in a variety of cells, including fibroblasts, keratinocytes and endothelial cells
Epidermal Growth Factor (EGF)
323
Cell produces GM-CSF
Activated T lymphocytes
324
Predominant type of collagen in scar tissue
Type 1
325
Facilitates epithelial cell anchoring
Laminin
326
This can reduce lean body mass and protein loss in children with large surface area burns
Synthetic testosterone (Oxandrolone) and Propranolol
327
What cells produce Interferon (IFN)?
Lymphocytes and fibroblasts
328
Amino acid considered vital to the immune system
Arginine
329
Most common organism associated withcatherlter sepsis from long term TPN
Staphylococcus aureus
330
Amino acid precursor of Gluconeogenesis
Alanine
331
Nutritional deficiency if patient has unexplained lactic acidosis
Thiamin
332
Earliest metabolic signs of systemic sepsis
Glucose intolerance
333
Multitrace elements as MTE-5
5 elements
Zinc
Copper
Chromium
Manganese
Selenium
334
Vitamin deficiency caused by gastric or ileal resection
Vit B12
335
Elemental deficiencies associated with gastric bypass surgery
Iron deficiency --- duodenal bypass = microcytic anemia
Vit B12 deficiency --- gastric resection = lack of intrinsic factor
336
Electrolyte deficiency for inducing post-CABG ventricular tachycardia
HypOMagnesemia
337
Marker of visceral protein stores
Transferrin
338
Test that can predict the need for stress dose steroids perioperatively in a patient with recent steroid use
ACTH stimulation test
339
At normal body temp, what is the average daily insensible water loss?
600-900 mL/d or 8-12 mL/kg/d
340
Hallmarks of hypOkalemia
Respiratory impairment
Paralysis
Hyporeflexia
Flat T waves
Depressed ST segment
341
Common causes of hyperosmolar hypONatremia
Hyperglycemia
Mannitol
Radiologic contrast
342
Primary electrolyte effects of aldosterone
Sodium retention and urinary potassium and hydrogen ion loss
343
Medications can increase serum K
Beta blockers
ACE inhibitors
344
Electrolyte deficiency associated with acute pancreatitis
HypOCalcemia (2nd 24hr Ranson criteria)
345
Severe hyperkalemia
Peaked T wave
Tx with Ca to stabilize the cardiac membrane
346
Electrolyte abnormality associated with vomiting and NG suctioning
HypOKalemic
HypOChlosremic
Metabolic Acidosis
Tx with saline and potassium
347
Overly rapid correction of Hyponatremia causes
Central pontine myelinosis
348
Overly rapid correction of hypernatremia causes
Cerebral edema
349
At or above which nerve root is respiratory failure worsened in spi al injury
C2
350
Hemodynamic parameters associated with sepsis
Low SVR
High CO
Normal PCWP
351
Palmar blush within 7 secs of ulnar artery release
Normal Allen test
352
Typical PA catheter measurement in hypovolemic shock
Low CO
High SVR
Low PCWP
353
Drug effective againts aerobic gram neg bacilli (pseudomonas), enterococci, staph, strep
MOA: inhibit ribosome function
Risks: prolonged neuromuscular blockade, ototoxicity, nephrotoxicity
Aminoglycosides
354
MoA of bacterial resistance to aminoglycosides
Inhibition of active transport of the drug into the bacterial cell
355
Red man syndrome
Vancomycin
356
Mechanism of bacterial resistance to vancomycin
Altered bacterial cell walls
357
Agent used to treat Vancomycin resistant enterococci (VRE)
Linezolid
Chloramphenicol
Novobiocin
Synercid
Teichoplanin
Quinolones
Doxycycline
358
Major intracellular anions
Proteins
Phosphates
359
Burn patients
Green slime infection on burns
Sweet smell
Pseudomonas
360
Mitral valve abnormalities can lead to large v waves on PA wedge tracing
Mitral stenosis
Mitral regurgitation
---d/t overfilling of left atrium
361
How to diagnose VAP
BAL - bronchoalveolar lavage
362
Variables determining O2 content
Hgb
O2 sat
PaO2
363
% of available oxygen extracted by heart
70%
The coronary sinus has the LOWEST PO2 of any vessel in the body
364
Physiologic effect of CPAP
Increase FRC and VC associated with decreases work of breathing
365
Mortality rate for patients with multiple organ failure (MOF) complicated by acute renal failure
75 to 90%
366
Acute compensation for metabolic acidosis
Respiratory (hyperventilation) alkalosis
367
Role of pressure control ventilation (PCV)
To minimize ventilator-associated barotraumas by delivering vol until a set peak airway pressure is reached. Of greatest utility in ARDS and requires paralysis with heavy sedation
368
Pitfall of PANCURONIUM as in ICU paralytic agent
Hepatic metab and renal excretion make prolonged neuromuscular blockage a concern in patients with multisystem organ failure
CISATRACURIUM is metabolized by pseudocholinesyerase and thus has become the ICU paralytic agent of choice
369
MC cause of hypercalcemia
Hyoeroarathyroidism
Cancer with bony metastases
370
Where does EDRF arise
It is nitric oxide and released from endothelial cells
NO precursor is arginine
NO is a smooth muscle relaxing factor and promote vasodilation
371
MOA of Atrial Natriuretic Peptide (ANP)
Sodium overload and retention rsults in vol overload that distends the atria. Atria then release ANP, which causes an increase in renal vasodilatation and natrouresis
372
Prostaglandins in sodium homeostasis
Prostaglandin synthesis is increased in states of absolute effective volume depletion and serves to maintain GFR and excretion of salt and water.
Inhibition of prostaglandin synthesis (NSAIDs) under these circumstances can lead to a decline in GFR and sodium overload.
373
Perioral numbness/tingling
Hyperactive deep tenson reflex
Cvostek's sign
Trousseau sign
Classic signs of HYPOCALCEMIA
374
Hypertensive, hypokalemic syndromes
Primary HypEr aldosteronism
2ndary HypEr aldosteronism
Cushing syndrome
375
Dx of PE
Area of lung consolidation with rounded border facing the hilus
Hampton's hump
376
Dx of PE
Dilated pulmonary outflow tract ipsipateral to emboli with decreased perfusion distal to lesion
Westermark's sign
377
Most reliable measure of glomerular filtration
Creatinine clearance
378
Common pathophysiologic pathway of ARDS
Injury to alveolar-capillary interface
379
Weakness
Twitching
Lethargy
Obtundation
Irritability
Seizures
Cerebral hemorrhage
HyperNAtremia
380
MC cause of volume deficit encountered in surgery
Loss of isotonic fluid
381
Conditions where CO2 production increased
Lipogenesis
Fever
Hyperthyroidism
382
Class of hemorrhagic shoch consistent with a drop in systolic BP
Class III
383
Class of hemorrhagic shock with loss of 15% to 30% of circulating blood volume, tachycardia, and decrease pulse pressure
Class II
384
Preferred position of patients suspected of ahving air embolism
Left lateral decubitus
385
Best initial fluid management for patient with hemorrhagic shock
Lactated ringer
386
Best initial fluid management for patient with hemorrhagic shock
Lactated ringer
387
Best initial fluid management for patient with hemorrhagic shock
Lactated ringer
388
Treatment options for patients with massive PE and acute cor pulmonale
Volume resuscitation and vasopressors
Then heparin, thrombolytics or surgical embolectomy
389
MC cause of cardiogenic shock in the setting of an acute MI
Greater than 40% loss of LV myocardium
Ventricular wall rupture
Septal rupture
LV aneurysm
Acute mitral regurgitation caused by papillary muscle rupture or dysfunction
390
Pt BP drops significantly after administration of nitroglycerin in the setting of an acute MI
Inferior wall MI w/ RV involvement
391
Main determinant of serum osmolarity of ECF space
Serum sodium concentration
392
Complications in massive blood transfusion
Electrolyte and acid-base abnormalities (alkalosis)
Changes in hemoglobin-oxygen affinity (decreased 2,3 DPG)
Hypothermia
Dilutional coagulopathy
393
Complications in massive blood transfusion
Electrolyte and acid-base abnormalities (alkalosis)
Changes in hemoglobin-oxygen affinity (decreased 2,3 DPG)
Hypothermia
Dilutional coagulopathy
394
Major source of tumor necrosis factor (TNF) following hypoperfusion
Liver and gut
395
Major source of tumor necrosis factor (TNF) following hypoperfusion
Liver and gut
396
TOC for wide complex tachycardia of uncertain etiology
Amiodarone or Lidocaine
397
Pt presents with inferior wall MI
Now hypotensive
Distended neck vein
Clear lung fields
Dx?
RV infarct or ischemia
398
TOC for hyperKalemia-induced cardiac arrythmia
IV calcium gluconate
399
Normal dietary intake of potassium
50-100 mEq/d
400
A mass of bowel and solid viscera in the central abdomen covered by translucent peritoneal covering membrane
Omphalocele
--- more frequently associated with congenital anomalies
401
Absence of peritoneal covering
Abdominal wall defect typically to the RIGHT of midline
Typically only small bowel herniated
Gastroschisis
402
Primary closure of gastroschisis
Intragastric pressure <20cm H2O and
CVP does not increase by 4mmHg or more
403
Type of renal calculi associated with hx of Distal Ileum resection
Calcium Oxalate stones
404
Type of renal calculi associated with hx of Distal Ileum resection
Calcium Oxalate stones
405
MC site of ureteral injury
- Near pelvic brim
- INFUNDIBULOPELVIC LIGAMENT
- base of broad lig where ureter crosses the uterine artery
- URETOVESICAL junction where ureter moves medially to insert into bladder
406
During hysterectomy, when do most ureteral injury occur
During clamping the uterine vessels or ligation of infundibulopelvic ligaments
407
Pt with varicocele of left testicle
Check for retroperitoneal or renal mass because left gonadal vein drains into L renal vein
408
Surgical precedure MC results in vesicovaginal fistulas
Rotal abdominal or vaginal hysterectomy
409
Trauma patient has blood at urethral meatus and hig-riding prostate
What test to order?
Retrograde urethrogram before placing the Foley.
If urethral disruption has occured, suprapubic cystostomy should be placed
410
Difference of L and R ureters in their pelvic course
Left ureter enters pelvis and cross common iliac artery MORE MEDIALLY thank the right ureter
411
MC cause of painless hematuria in children
Glomerular lesion
412
Function of ANP (atrial natriuretic peptide)
Relaxes vascular smooth muscle
Decrease sympathetic stimulation and inhibits renin and aldosterone secretion
413
MC cause of acute left varicocele
Renal vein occlusion (commonly related to renal tumors)
414
Severe testicular pain
Testicular torsion
Must be corrected within 4HOURS before irreversible damage occurs
415
Kidney stone associated with perinephric abscesses
Struvite or staghorn calculi
416
MC manifestation of metastatic gonococcal infection
Gonococcal arthritis
417
Kidney stone associated with primary hyperparathyroidism
Hydorxyapatite crystal predominance
418
Percentage of urinary tract stones are radiopaque
90%
419
Best test to detect prostate cancer
DRE and PSA
420
MOA of Alpha blockers (flomax) in tx of BPH
Relax smooth muscle and partially relieve the dynamic component of obstruction
421
MC cancer affecting kidney
Renal cell Carcinoma
422
MC cancer affecting kidneys in childhood
Wilm's tumor (adenomyosarcoma)
423
Triad of
Pain
Palpable mass
Hematuria
Renal tumor
Occurs late
424
MC tumor affecting renal pelvocalyceal system
Transitional cell carcinoma
425
55yo male
Gross hematuria
Renal colic
IVP - filling defect in left mid ureter
Dx?
Transitional cell carcinoma
426
MC testicular tumor in older male
Most RADIOSENSITIVE
Seminoma
427
Testicular tumor with WORST prognosis
Choricarcinoma
428
Tumor markers to check before orchiectomy
HCG (seminomatous)
AFP (nonseminomatous)
Obtain abdominal CT staging before surgery
429
Sperm count of a healthy male
Between 30 and 100 million sperm/mL with at least 70% showing purposeful motility
430
Indications for sx who sustained traumatic renal injury
Urinary extravasation
IV contrast blush on CT outside renal capsule
Persistent retroperitoneal bleeding
Nonviable tissue
431
Best sx approach for renal exploration after trauma
Midline abdominal
432
MC cause of ureteral injury
Iatrogenic injury during abdominal procedure
433
MC cause of traumatic bladder injury
Pelvic fracture with penetration of bladder by bone spicules
434
MC cause of urethral injury
Pelvic fracture or perineal penetration (saddle injury)
435
MC fusion defect of urethra
Hypospadias
436
MC location of urethral meatus in patient with hypospadias
Distal end of penile shaft, ANTERIORLY
437
Standard oncologic procedure for ovarian cancer
TAH/BSO, omentectomy and peritoneal fluid cytology
Peritoneal surface serosal debulking
Ovarian CA is the LEADING FATAL GYN MALIGNANCY caused by typical advanced stage and presentation
438
MC neoplasm in reproductive-aged woman
Benign leiomyoma
439
Best predictor of recurrence-free interval for early stage leiomyosarcomas
Mitotic index
440
Side effect of Tamoxifen (anti-breast CA drug)
Increase risk of endometrial CA and uterine sarcoma
Increased DVT rate
Cataract formation
441
Side effect of postmenopausal hormone supplementation (estrogen/progesterone)
Increase rate of CAD
Breast CA
Endometrial CA
442
Benefits of postmenopausal hormone supplementation (estrogen/progesterone)
Decreased rate of Osteoporosis
Colorectal cancer
443
MC complaint of women with cervical cancer
Menorrhagia
444
MC site of ecropic pregnancy
Ampulla of fallopian tube
445
6yo
Prematur thelarche
Tanner stage 4 breast
Cafe au lait spots
Ovarian cysts
McCune-Albright syndrome
446
MC cailuse of Otitis media in newborn
E. Coli
447
MC cause of stridor in newborn
Laryngomalacia
448
MC malignant salivary tumor
Mucoepidermoid CA
449
MC malignant salivary gland tumor of submandibular glands
Adenoid cystic carcinoma
450
MC benign salivary tumor
1. Pleomorphic adenoma
2. Warthin's tumor (10% bilateral)
451
Part of airway with greeatest degree of inflammation in child with laryngotracheobromchitis (croup)
Subglottic region
452
Illa appearing patient
Fever
Bilateral chemosis
3rd nerve palsy
Sinusitis
Dx?
Cavernous sinus thrombosis
453
MC type of malignant neoplasms of nasopharynx in adults
Squamous cell CA
454
48yo male
High fever
Trismus
Dysphagia
Swelling inferior to mandible in lateral neck
Dx?
Parapharyngeal abscess
455
Structures removed in classical radical neck dissection
SCM
Internal Jugular Vein
Spinal accessory nerve
Submandibula salivary gland w/ associated lymph node bearing fibro fatty tissue
456
MC cause of acute otitis media in children
S. Pneumoniae
Haemophilus influenza
Moraxella catarrhalis
457
Salivary gland stones most common location
Submandibular gland
458
Clinical features of basal cell carcinoma
Raised, waxy nodule with occasional erythema
459
Household prophylaxis with acute epiglottitis
Rifampin 20mg/kg (max 600mg) for 4 days
460
Prevertebral soft-tissue widening
Airfluid levels
Loss of cervical lordosis
Cervical osteomyelitis
Dx?
Retropharyngeal abscess
461
Lateral neck mass (posterior triangle)
Mass is soft and transilluminates
Excision is recommended
Cystic hygroma
462
Lateral neck mass (anterior border of SCM)
More firm
Causes skin buckling or indent
Brachial cleft cyst
463
MC bacterial cause of acute sinusitis
Pneumococcus
H. Influenza
464
MC bacterial cause of malignant external otitis
Pseudomonas aeruginosa
465
Most frequent neuro complication of malignant external otitis
Facial nerve palsy
466
MC organism associated with acute suppurative parotitis
Staphylococcus aureus
467
Recurrent, painful swelling of the side of the face at lealtime
Resolves withi 2-3 hrs
Dx?
Sialolithiasis
468
Superior laryngeal nerve injury results to
Loss of sensation above vocal cords
Impairment of laryngeal protective reflexes
Hoarseness
Limited vocalization of high pitched tones (external branch)
469
Salivary gland tumor has well known propensity for extension along perineural spaces and invasion of bone
Adenoid cystic carcinoma
470
Cranial nerve derivative of 2nd brachial arch
VII (geniculatr ganglion)
471
4th and 6th arch derivatives innervated by?
4th - Superior laryngeal nerve
6th - Recurrent laryngeal nerve
472
Nystagmus component
Fast component
Slow phase - vestibular origin, direction of endolymph flow
Fast phase - compensatory from reticular formation
473
MC site of salivary gland tumors
Parotid gland
474
MC malignant tumor of parotid gland
Mucoepidermoid carcinoma
475
MC malignant tumor of submandibular gland
Adenoid cystic carcinoma
476
Painless mass below ear
Slowly enlarging for 2-3 years
Patho: plump, round, granular eosinophilic cells with small indented nuclei
Dx?
Warthins tumor (adenolymphoma)
2nd MC parotid malignancy overall
477
Sensory distribution of which CN is responsible for the sensory distribution of referred otalgia
CN 5, 9, 10
478
Sole abductor of the vocal cords
Posterior CricoArytenoid
479
Intrinsic laryngeal muscles responsible for tension of vocal cords
CricoThyroid (Chief Tensor)
ThyroArytenoid (Internal Tensor)
480
6yo
Dysphagia
Fever
Noisy breathing
Muffled voice
Neck is stiff
Rigid posturing of his head
RetroPharyngeal abscess
481
Location of parathyroid gland in a 10yo with lingual thyroid gland
TracheoEsophageal groove
482
Infant
Triad of:
Coughing
Choking
Cyanosis during feeding
Tracheoesophageal fistula
483
MC source of anterior epistaxis
Septal branches of SphenoPalatine artery and branches of Anterior Ethmoidal and Facial arteries
484
CN affected in skull base lesion
CN 7 and 8
485
MC lesion of cerebellopontine angle or skulll base
Acoustic neuroma
---1st finding: unilateral sensorineural hearing loss
486
Which lip commonly affected by sun exposure induced carcinoma
Lower lip
487
MC histopath for lip cancer
SCC
488
Syndrome associated with post cricoid carcinoma in nonsmoking young women
Plummer vinson syndrome
489
Anatomically divides zones 3 and zone 4
Omohyoid muscle
490
MC cause of CSF leak
Basilar skull fractures
491
Therapy for patient with Hemophilia A who suffered traumatic brain trauma
Cryoprecipitate
492
Subdural vs epidural hematoma
More deadly?
Subdural hematoma
493
MC primary malignant brain tumor
Glioblastoma multiforme (GBM)
494
Segment of vertebral artery most frequently involved in traumatic dissection
Segment between 2nd cervical veryebra and occiput (3rd portion of vertebral artery)
495
MC type of Odontoid Fracture
Type II (fracture through base of dens)
496
Spinal abnormality in patients with Rheumatoid arthritis
Atlantoaxial subluxation
497
Penetrating trauma with ½ cord transection
Loss of ipsilateral motor and contralateral pani and temp
Brown sequard syndrome
498
MVA of elderly patients w/ HYPEREXTENSION injury.
Bilateral loss of upper extremity motor pain and temp
Leg retain function
Central cord syndrome
499
Bilateral facial paralysis associated with progressive ASCENDING motor neuropathy of lower extremity and elevated CSF protein characteristic of
Guillian-Barre syndrome
500
Bilateral acoustic neuromas
Neurofibromatosis II
501
Single or multiple sharply circumscribed osteolytic lesions most frequently found on the skull
Histiocytosis X
502
HIV (+)
Seizure
2 ring-enhancing brain lesions
Dx?
Toxoplasmosis or
CNS lymphoma
503
Pt w/ 3rd nerve palsy
Recent episode of excruciating headache
Dx?
Posterior Communicating Artery Aneurysm
504
Phenomenon in the setting of uncal herniation where temporal lobe herniation displaces the brainstem against the opposite tentorial edge and causes symptoms of contralateral brainstem injury and ipsilateral hemiparesis
Kernohan's notch syndrome
505
Primary toxicity risk of HALOTHANE anesthesia
Hepatitis w/ fever
Eosinophilia
Jaundice
506
Antiemetic agent increases gastric motility
Reglan (Metoclopramide)
507
Sedation agent in children that increases cardiac work, secretions, and BP and is NOT associated with respiratory depression
Ketamine
508
Muscle first to recover from paralytic therapy
Diaphragm
509
Lidocaine toxicity
Neurologic signs - paresthesia, headache and tinnitus
For general or MAC anesthesia, cardiac arrythmia 1st sign
510
Toxic dose of lidocaine
No epi - 5mg/kg
W/ epi - 7mg/kg
511
Medicine associated with decrease splanchnic blood flow
- used in GI bleeds
VASOPRESSIN
512
Patients that may have detrimental side effects from SUCCINYLCHOLINE
Closed angle glaucoma
Space occupying intracranial lesions
Severe crush injuries of lower ex
513
Treatment for MALIGNANT HYPERTHERMIA
cessation of anesthesia
DANTROLENE
general supportive measures
514
Primary toxicity of MEPERIDINE (Demerol)
Neurotoxic metabolites (accumulates in pt with renal insufficiency)
Papillary dilation
Seizures
515
Best time to administer oral RANITIDINE for prophylaxis againts acid aspiration
60 mins before induction of anesthesia
516
Single most important factor predicting postoperative cardiac morbidity
Hx of Congestive Heart Failure (CHF)
517
Potential adverse side effect of PROPOFOL
Hypertriglyceridemia w/ chronic use
Vasodilation
Hypotension
Respiratory depression
518
MOA of METOCLOPRAMIDE
Inhibits dopamine and enhances the release of acetylcholine, resulting in an increased rate of gastric emtying and increased LES tone.
Inhibits chemoreceptor zone
519
Extrapyramidal effects of DROPERIDOL
Acute dystonia
Parkinsonism
Akathesia
520
Single most important factor that determines the length of stay after general anesthesia in ambulatory patients.
Postanesthesia nausea
521
How NEOSTIGMINE decrease postop nausea and vomiting
Increases LES pressure and counteracts the increased risk of regurgitation of gastric contents after atropine administration
522
MC peripheral nerve injury associated with prolonged general anesthesia
ULNAR neuropathy from prolonged compression of elbow
523
Result of intra arterial injection of THIOPENTAL
Crystal formation and local Norepi release that may culminate in thrombosis and severe ischemia of extelremity
524
Factors determine cerebral blood flow
Arterial CO2
O2 tension
Systemic arterial BP
Head position
Jugular venous obstruction
Positive end-expiratory pressure (PEEP)
525
Moat sensitive indicator of a falling cardiac output (CO) during surgery
Mixed venous oxygen tension will DECREASE
526
Core body temp cardiac arrhthmia begin to occur
23 C
527
Inhalation agent worst offender in terms of sensitizing the myocardium to catecholamines
Halothane
528
Only neuromuscular blocking agent essentially devoid of cardiovascular side effects
Best in ambulatory patient who is particularly sensitive to blood pressure changes
Vecuronium
529
Local anesthetic has the longest half-life
Bupivacaine (marcaine)
4-6 hrs total duration
530
Advantage of PROPOFOL instead of thipental for induction &/or maintenance in pedia patients undergoing ambulatory surgery
Well tolerated technique in children
Superior recovery
Extremely low incidence of vomiting
531
SEVOFLURANE vs isoflurane in adult ambulatory surgical patients
Faster recovery and decrease side effects
532
Landmarks in performing a midline lumbar spinal block
Iliac crest and
L4 and L5 spinal process
(And/or L3 spinous process)
533
Feared toxicity of KETOROLAC
Renal toxicity
534
Best parameter in predicting successful weaning from mechanical ventilation
Rapid shallow breathing index(RR/TV)
535
Factors can impair phagocytosis of bacteria
Bacterial encapsulation
Uremia
Prematurity
Leukemia
Hyperglycemia
536
Toxic portion of endotoxin LipoPolySaccharide protein complex
Lipid A
537
MOA of quinolones
Inhibit DNA gyrase , which is needed to package DNA into dividing bacteria
538
Best time to begin prophylactic antibiotic therapy for elective surgery
Within 1hour prior to operation
539
MC inciting bacteria for burn wound infection
1st week - S. aureus
After weeks of hospitalization - Gram neg Pseudomonas
540
48h post op
Severe pain in midline wound
Skin bullae
CREPITUS
Irregular blanching at wound margin
Fever 104F
Dx?
Clostridial gas gangrene
Clostridium perfringes
Tx: pen G / Clindamycin in PCN allergic patients
+ emergent surgical debridement
Monitor urine for signs of hemolysis
541
Proper tx for iatrogenic transection of CBD
End to end anastomosis (EEA) over a T-tube stent when portion of CBD is injured or choledocojejunostomy for complete CBD transection
542
Structure most commonly injured if Triangle of Calot is not identified during cholecystectomy
Right Hepatic Artery
543
TOF patient with amebic liver abscess
Metronidazole
544
MC cause of small bowel obstruction
Small bowel adhesion
545
Severe wt loss
Steatorrhea
Hx extensive small bowel resection
Cause of symptoms?
Resection of ILEUM (insufficient bile salt absorption)
546
Initial therapy for patients with Clostridium difficile colitis
Oral Metronidazole or Vancomycin
W/severe ileus - IV Metro/Vanco
***Metro contraindicated with pregnant!!
547
Appropriate surgical therapy for toxic C. difficile with Toxic Megacolon
Total colectomy and End Ileostomy
Clinical signs:
Colonic pneumonitis
Portal circulation gas
Peritonitis
Sepsis
548
Bacteria most commonly reported as the sole cause of NONCLOSTRIDIAL NECROTIZING SOFT-TISSUE INFECTION
Group A beta-hemolytic Streptococcus
549
Tx for diabetic foot w/osteomyelitis, scending cellulitis of lower leg and systemic signs of sepsis
Guillotine amputation below the leg
550
MC organism associated w peritonitis in patients receiving peritoneal dialysis
S. aureus
S. epidermidis
551
Fungal infection in immunocompromised (lungs)
Airborn transmission
Once in the lung, disseminate to bone and soft tissue necrotizing effect can occur
Aspergillosis clinical features
