1
Q
What makes up the classic triad of chronic pancreatitis?
A
Steatorrhea, diabetes mellitus, and calcifications on imaging.
2
Q
What is the tx plan for a pt with active cancer and has a DVT?
A
Initial coagulation should be started with a direct factor Xa inhibitor (e.g., apixaban, rivaroxaban, edoxaban) as the anticoagulant of choice, provided that the patient has no kidney insufficiency for 3-6 months before reassessing
because they are at a higher risk of bleeding complications
3
Q
What dx? What dz is it associated with?
A
pyoderma gangrenosum
ulcerative colitis
4
Q
Noncaseating granulomas in the bowel wall and mesentery are the classic microscopic characteristic of _____.
A
Crohn disease
5
Q
while microscopic views of the colon will demonstrate polymorphonuclear leukocyte (PMN) cells and abscesses in the bowel wall crypts. What dx?
A
ulcerative colitis
6
Q
_____ is an important cause of achalasia worldwide
A
Chagas disease
7
Q
What am I? What dx am I associated with? What is the next best step?
A
wet gangrene
PAD
immediate surgical debridement followed by revascularization as soon as safely possible
8
Q
What risk stratification tool is used to assess upper gastrointestinal bleeding?
A
The Glasgow-Blatchford score.
9
Q
An irregular, erythematous plaque with a hemorrhagic crust. What dx?
A
squamous cell carcinoma
10
Q
What pt population is an obturator hernia MC in?
A
older women between 70-90 years old and will present like a SBO
11
Q
Howship-Romberg sign is the most specific physical exam finding associated with _________
A
obturator hernia
pt lying supine, knee flexed and externally rotated illicits plain. This sign is positive when pain extends down the medial aspect of the thigh with movement of the knee.
12
Q
What are the 2 different types of gastric cancer? Which one is similar to adenocarcinoma?
A
intestinal type and diffuse type
intestinal type
13
Q
Which virus has been associated with an increased risk of gastric cancer?
A
Epstein-Barr virus.
14
Q
What is the MC symptom of a posterior cerebral artery stroke?
A
homonymous hemianopia with or without sparing of the macula
15
Q
______ is the MC artery involved in a stroke
A
middle cerebral artery
16
Q
What artery is implicated in “locked-in” syndrome?
A
basilar artery
17
Q
What is the most common type and location of pancreatic cancer?
A
adenocarcinoma in the head of the pancreas
18
Q
What is the second most common histologic type of pancreatic cancer?
A
mucinous cystadenocarcinoma
19
Q
The _____ classification categorizes anal fistulas based on their relation to the anal sphincter muscles.
A
Parks
20
Q
What is a Marjolin ulcer?
A
is a type of squamous cell carcinoma that develops in a chronic nonhealing wound
21
Q
What infectious organism are enterocutaneous fistulas associated with?
A
Mycobacterium tuberculosis.
22
Q
What is the tx for a pt who is having an allergic reaction to vanc?
A
suspend vanc and give antihistamine (Benadryl)
23
Q
Treatment of a Zenker diverticulum _____ (what size) is surgical.
A
Treatment of a Zenker diverticulum > 1 cm is surgical.
24
Q
Breast pain with a women under 30, what imaging should you order?
A
US of breast that is painful
25
Breast pain with a women 30-39 years old, what imaging should you order?
US of breast in pain and bilateral OR focused mammogram
26
Breast pain with a women over 40, what imaging should you order?
US of breast in pain and BILATERAL mammogram
27
Increased fibrin degradation products and schistocytes on peripheral smear are consistent with the diagnosis of _____
DIC
28
What is the MC cause of disseminated intravascular coagulation (DIC)?
Infection is the most common cause of DIC and is often caused by sepsis from gram-negative organisms
29
What are the three most important naturally occurring anticoagulants?
Protein C, protein S, and antithrombin III
30
What is the Parkland formula for fluids for burn victims?
(4 mL/kg x body weight in kg x percent of body surface area burned) is used to determine the fluid requirements in the first 24 hours for burn patients. Half of the required fluid is given in the first 8 hours, and the remaining fluid is given over the next 16 hours.
31
Primary upper extremity DVT, also known as _____, is rare and due to _______
Paget-Schroetter syndrome
venous thoracic outlet syndrome
32
What is the most common location for colorectal carcinoma?
sigmoid colon
33
What are the s/sx of hyperkalemia? At what level is calcium needed to stable the heart?
muscle weakness, flaccid paralysis, cardiac dysrhythmias, and ileus
calcium is indicated when the potassium is > 6.5 mmol/L regardless of ECG findings
34
What is pernicious anemia caused by?
lack of intrinsic factor that results in vit b12 deficiency
Intrinsic factor is a protein secreted by the parietal cells in the stomach
35
In a FAST exam, normal lungs will demonstrate the presence of ____ and ______ and the absence of these findings indicates a pneumothorax.
lung sliding
comet tails
36
What vessel is MC involved for an acute mesenteric ischemia?
superior mesenteric artery
37
What is Ranson criteria for acute pancreatitis?
38
What is the MC indication for URGENT preop dialysis?
hyperkalemia and volume overload
39
What is the criteria for urgent preop dialysis for hyperkalemia?
Patients who have hyperkalemia with a potassium of at least 6.3 mEq/L
OR
pt's who have any level of hyperkalemia with electrocardiogram changes must be dialyzed prior to surgery
for elective surgeries, anesthesiologists typically want K to be less than 5.5
40
When should hemodialysis patients be dialyzed prior to elective surgery?
the day before sx
41
What is the appropriate INITIAL dx study of choice for aortic dissection in a unstable pt? stable?
unstable: TEE
stable: CTA
42
What dx? What is the first line tx of choice? What dx test?
esophageal spasm
CCB then move on to TCA if CCB does not work
esophageal mamometry
43
If manometry reveals an elevated integrated relaxation pressure of the esophagogastric junction, ____ is identified.
achalasia
will have ELEVATED relaxation pressure
44
What is the most diagnostic finding of appendicitis?
appendiceal diameter > 6 mm
45
When should an US be order for appendicitis?
body mass index < 25 kg/m2 and most pediatric patients
46
How many hours from diagnosis should surgery occur within for acute nonperforated appendicitis?
12 hours
47
What are the watershed areas of the colon?
the splenic flexure and rectosigmoid junction
48
______ is the preferred technique used to biopsy most breast lesions that are suspicious for malignancy
Core-needle biopsy
49
The most common bariatric surgery performed is _______.
sleeve gastrectomy
50
A small pouch is created in the proximal stomach and a long limb of the small intestine is attached at the distal portion of the small stomach pouch. What procedure?
Roux-en-Y gastric bypass
51
Which bariatric surgery is most effective at reducing the risk of diabetes mellitus?
Biliopancreatic diversion with duodenal switch.
52
When is the HPA axis considered suppressed? What do you need to do pre-op?
The HPA axis is considered suppressed in patients taking prednisone-equivalent doses > 20 mg/day for more than three weeks or patients with clinical evidence of Cushing syndrome secondary to exogenous glucocorticoid use
IV hydrocortisone in pre-op
53
What is considered intermediate risk for HPA axis suppression? What should you do next?
those taking prednisone-equivalent doses of 5 to 20 mg PO daily for more than three weeks.
The best initial test is a morning cortisol level after a glucocorticoid-free period of 24 hours.
54
After morning cortisol level test was completed, patients with cortisol levels ______ need perioperative glucocorticoids. A morning cortisol level ______ indicates the HPA axis is not suppressed, and therefore, perioperative glucocorticoids are unnecessary.
cortisol < 5 mcg/dL NEED preop steroids
cortisol > 10 mcg/dL do not need steroids
55
Which baseline laboratory value should be checked prior to initiating statin therapy?
Aminotransferase and creatine kinase (CK) levels.
56
_____ and _____ should be initiated in pts with stable angina to REDUCE adverse cardiac events
statin and antiplatelet (ASA or plavix)
57
What should the peak expiratory flow rate be for patients with asthma before elective surgery?
> 80% of their predicted value.
58
What am I?
Reed-Sternberg cells
Hodkins lymphoma
59
_____ is the best way to diagnose a strangulated groin hernia in patients who do not have obesity.
Clinical exam
60
Normal alkaline phosphatase with normal aminotransferase levels in the setting of jaundice suggests _____ or ______ or ______
hemolysis
Gilbert
Crigler-Najjar syndrome
61
Predominant elevation of serum alkaline phosphatase in relation to the serum aminotransferases suggests ______ or ______
intrahepatic cholestasis
biliary obstruction
62
An elevation in both GGT and alkaline phosphatase suggests ______
cholestasis
63
______ infections are the most common cause of necrotizing fasciitis.
Group A Streptococcus
64
What is the indication for immediate surgical repair for AA?
if the aneurysm is greater than 5.5 cm in diameter or has grown more than 0.5 cm in the last six months,
65
What is the screening recommendation for AAA that measuring 5.0-5.4cm?
then repeat imaging with either an ultrasound or computed tomography should be completed every six months.
66
What is the screening recommendation for AAA that measuring 4.0-4.9 cm?
then it should be monitored with ultrasound imaging every 12 months.
67
What is the screening recommendation for AAA that measuring 3.0- 3.9 cm?
then imaging should be completed every three years.
68
What type of bile duct stones is most likely to be found in PRIMARY choledocholithiasis?
pigmented stone
69
What is the difference between primary and secondary choledocholithiasis?
primary -> when stones originate in the common bile duct
secondary -> when stones originate in the gallbladder and are then passed into the common bile duct
70
Edema, basal cell hyperplasia, and increased type III collagen deposition are seen on esophagogastroduodenoscopy with biopsy. What dx?
esophageal stricture
71
dysphagia with solid food only should make you think ______
vs
dysphagia with solid and liquid food should make you think _______
solid food only -> esophageal stricture
solid and liquids -> achalasia
72
long-acting sulfonylureas (glimepiride, glyburide, glipizide) need to be held how long before surgery?
metformin needs to be held ____ hours before sx?
48-72 hours before sx
24 hours
73
_______ type of thyroid cancer is associated with MEN type 2, hyperPTH, and pheochromocytoma
medullary
74
What is the MC type of thyroid cancer? What is it associated with?
papillary
head/neck radiation exposure
75
Colonoscopy demonstrates friable, edematous mucosa, bluish hemorrhagic nodules, and interspersed pale areas in the affected segment of the bowel. What dx?
colonic ischemia
76
colonic ischemia is MC in what 2 areas of the colon?
splenic flexure and rectosigmoid junction
aka watershed regions
77
What BP medication should be utilized in SAH?
nimodipine
78
What are 3 s/sx consistent with LEFT sided colorectal cancer?
change in bowel habits, hematochezia, think stools
79
External hemorrhoids are associated with the ______ and are associated with more pain than prolapsed internal hemorrhoids
inferior hemorrhoidal plexus
80
Internal hemorrhoids arise from ________ and are commonly found at what areas of the canal?
internal hemorrhoids -> superior hemorrhoidal cushion
right anterior, right posterior and left lateral
81
What is the tx for postoperative drug eruption? What timeframe?
topical steroid cream and PO hydroxyzine
typically occur 5-14 days after initial exposure
82
______ is a common symptom of ischemic colitis but is rarely seen with chronic mesenteric ischemia
bloody stool
83
arterial bleeding between the pia and arachnoid layer. What dx?
SAH
84
tearing of the veins between the dura and arachnoid space. What dx?
subdural hemorrhage
85
Lab studies show a prolonged partial thromboplastin time that normalizes with a mixing study. What dx?
hemophilia B
aka factor IX deficiency
86
nonpitting edema of the shins with brown plaques. What PE finding? What dx is it associated with?
pretibial myxedema
87
N/V/D from gastroenteritis from food poisoning is likely to lead to a decrease in what lab value?
hypoK due to excessive potassium loss from the GI tract
88
What organisms are most likely to cause hospital acquired PNA?
gram- negative rods
Pseudomonas aeruginosa
E. coli
Keblseia pneumoniae
89
________ is the hallmark PE finding in primary hyperPTH. Will calcium, PTH and phosphate levels be increased or decrease?
decreased tendon reflexes
primary PTH:
high calcium
high PTH
LOW phosphate
90
In secondary PTH, will calcium, PTH and phosphate be elevated or decreased? What is the underlying cause?
secondary PTH:
LOW calcium
high PTH
high phosphate
usually due to poor kidney function
This biochemical profile is most commonly seen in chronic kidney disease, where impaired phosphate excretion leads to hyperphosphatemia, and decreased renal synthesis of 1,25-dihydroxyvitamin D results in hypocalcemia. Both hypocalcemia and hyperphosphatemia stimulate increased PTH secretion
91
How will primary hyperPTH usually present?
The clinical presentation is due to hypercalcemia and may include kidney stones, abdominal pain, joint pain, and signs of depression
92
What is the best location to insert a chest tube?
mid-axillary line, 4th-5th intercostal space
93
Buttock, hip, or groin pain that is brought on with exercise or walking and relieved by rest is the hallmark presentation for a clot that is located in the ______ artery.
aortoiliac
common iliac artery
94
Thigh and upper calf pain with intermittent claudication is characteristic of a thrombus located in the _____ artery
femoral
95
What dx?
pancreatic psuedocyst
common complication of chronic pancreatitis
96
potential skin cancer greater than _____ needs a full thickness wide excisional bx
greater than 6 mm
97
What lab finding will most likely confirm the dx of Graves dz?
presence of thyroid-stimulating immunoglobulins
98
When does alcohol withdrawal symptoms start to set in?
12-48 hours after last drink
99
______ is the MC surgical emergency in pregnant pts?
appendicitis
100
For what cancer, in addition to breast cancer, are men with mutations in BRCA1 or BRCA2 at risk?
prostate cancer
101
What type of nerve block should be used for upper lip lacerations?
infraorbital nerve block
102
What type of nerve block should be used for lower lip lacerations?
intraoral mental nerve block
103
______ is the recommended first-line agent for thromboprophylaxis in patients undergoing abdominal or pelvic surgery due to cancer.
Low-molecular-weight heparin
104
What is the most common histologic type of breast cancer?
Infiltrating ductal carcinoma.
105
What is the proper location for the tip of an endotracheal tube on a chest X-ray?
3–5 cm above the carina
106
What nerve roots are responsible for the patellar deep tendon reflex?
L2 to L4.
PANCE prep
flashcards
Decks in class (32)
# Cards
-
MC90
-
Things I Want to Remember200
-
Cardio105
-
Heart Murmurs Sounds26
-
Pulm42
-
Things -part 257
-
Peds193
-
ER201
-
Derm28
-
MSK79
-
Endo26
-
EENT47
-
Women's Health129
-
Psych143
-
GI51
-
Hem41
-
Pulm3
-
Urology21
-
Nephro29
-
Neuro38
-
ER- Part 2191
-
Antibody, labs test, etc key associations79
-
High yield questions23
-
Surgery EOR101
-
Infectious Disease38
-
Surgery EOR part 2106
-
Surgery EOR part 329
-
Professionalism12
-
Preventative screening guidelines6
-
Internal Med EOR100
-
Cardio- Part 228
-
Peds - part 29
