Truelearn Flashcards
1
Q
primary hyper pth most commonly from….
what if localization studies are negative
A
primary adenoma single in 85%
prepare for bilateral neck exploration
2
Q
Inclusion and exclusion criteria for superficial surgical wound infections
A
3
Q
Malignant hyperthermia:
rec mutation?
inh pattern?
usual inciting medicaiton?
Other SEs of this medication? tx? MOA of med?
A
ryanodine receptor
AD
sux
hyperkalemia; dantrolene; depolarizing muscle blockade
4
Q
Pt populations to hold succinylcholine in ?
A
closed head trauma, burns, NM disease
5
Q
Standard approach for popliteal aneurysms?
Standard operation?
A
medial
exclusion with ligation and bypass with GSV
6
Q
describe RAAS components
A
7
Q
4 classes of pilonidal disease
A
8
Q
what PFTs must be met prior to pneumonectomy?
Lung resection?
A
fev1>80, DLCO>60, FEV1 >2L
8
Q
Hypermagnesemia severe range?
EKG changes?
Tx?
A
> 12
Pr interval prolongation
Ca; hydration and diuresis
9
Q
best test for elderly hip pain after fall
A
CT
10
Q
2 things that change goiong from class 3 to 4 shock?
A
lethargy/obtunded and absent uop
11
Q
atypical ductal hyperplasia has a —-% chance of harboring in situ or CA
A
15-30
12
Q
MC presentation and mammogram finding for DCIS
A
clustered microcalcs
13
Q
in what order do cell types show up in wound healing? approximate times?
A
Platelets - immed
Neutrophils - 24-48 —-cytokines, debris
Macroghages - 48-96
Lymphocytes
Fibroblasts
14
Q
3 stages of wound healing and predominant cell types
A
inflam -1-7d - neutrophils, mps, lymph
prolif - 3d-3wk –all
recon - 3wk - fibroblasts
15
Q
2 collagens in wound healing, when they show up and which is left?
A
3 and 1; 3 spikes in prolif and then 1 takes off and stays; fibronectin is also around
16
Q
what margins are required for a cancerous polyp snaring to be definitive
A
2mm margins with no base involvement
17
Q
wound classes and their % chance of SSI
A
18
Q
when and what multiple of amylase abnormality needs to be present to define panc leak
A
POD3 x 3
19
Q
differences between the vasculature of the adrenals
A
inf phreni, aorta and renal feed arterial supply b/l
right adrenal vein goes to IVC
left adrenal vein goes to left renal
20
Q
4 s/s of hypocalcemia?
A
perioral numbness
chevstock - cheek tap
Troussea -BP cuff and carpopedal spasm
prolong qt
21
Q
pancreatic injury grading
A
22
Q
confirmatory study for ischemic colitis
A
scope
23
Q
why altmeir of delorme in necrotic prolapse?
A
delorme just strips mucosa, may not see all full thickness
24
sensitivity?
25
ppv, npv?
26
specificity
27
amphotericin B MOA?
AE?
binds to fungal cell wall sterols
nephro
28
fluconazole MOA
AE
cell wall synth inhibit
29
capsofungin moa
D B glucan synthase inhibition
30
felon vs paronychia appearance?
MC bug?
definiive tx for felon and why is this so seriosous
felon is in volar pulp v infection under nail bed
staph
I&d ---- 75% necrosis possible
31
max ligasure vessel size
7MM
32
visceral Blood vessel diameters
splenic - 5mm
cha - 6mm
rha - 3mm
celiac - 8mm
sma - 8mm
ima - 5mm
33
MCC of cushing syndrome? endo v exo v overall
What is cushing disease
cush dis v steroids v steroids
pit tumor -- ACTH secreting
34
3 burn meds and their SEs
35
All sepsis pressors and their MOAs + receptors
36
what other deficiency can hypomagnesemia cause?
Calcium
37
GB cancer staging and next steps
38
what defines unresectable GB cancer
PV or hepatic artery
2 or more organs
39
Differing features among crohns and uc
crypt abscesses in uc, only colon and rectum, only mucosa and submucosa
40
burn grades and appearances
41
42
how does desmopressin work?
what if that does not work for uremic bleeding
increases factor 8 and vwf
dialysis
43
transfusion reaction types and their treatments
44
BIRADS?
45
what birads do we start biopsies
4
46
cushing diagnosis flow chart
47
Tx for branchial cleft cyst if infection concerns
always delay surgery, tx with abx in the meantime
48
tx of biliary injury iatrogenic and trauma
A single duct < 3 mm in size identified on cholangiography, draining a single segment/subsegment of liver can be primarily ligated; 4 mm or greater generally requires repair.
< 50% circumference injury, non-electrocautery: primary repair with 4-0 or 5-0 absorbable suture, placement of T-tube
> 50% circumference injury OR electrocautery: biliary-enteric reconstruction, typically Roux-en-Y choledochojejunostomy vs choledochoduodenostomy
49
What is involved in a superficial inguinal nod dissection?
when should a deep dissection be performed for melanoma?(3)
what is cloquets node
femoral canal nodes
cloquets is pos, large numbe of superficial nodes pos, or imaging concerns
50
what is the next step after deep inguinal node dissection
51
4 cancers associated with EBV
burkit lymphoma, gastric ca, nasopharyngeal, hodgkins
52
what cancers are assoc with li fraumeni
gene?
tp53
53
How to cover former trach site after repositioning pos innominate ligation
local strap muscle flap
54
preferred reversals for anticoags in head trauma
55
inflammatory breast cancer criteria
56
MC complication of hepatic trauma
bile leak
57
tx for symptomatic hemangioma in child
58
MC suppurative thrombophlebitis bug
staph aureus
59
normal systemic periph vasc resist. numbers?
what are elevated peak pressures?
700-1500
40
60
What must be repleted first in an altered gastric bypass patient with dehydration 6 weeeks later
thiamine as it is absorbed in the duo and jejunum
61
what incision do you choose for sma arteriotomy and why
transverse with healthy vessel
longitudinal if unhealthy and patch may be needed
62
How are sb hemangiomas dg and how should they be managed
CT IV
no intervention if asymptomatic
endo or IR can control bleeding
surgery if all else fails
63
2 most common sites for peripheral artery aneurysmsative sizes?
Pop then CF
2 and 2.5
64
CDH1 prophylaxis timing?
total gastrectomy 18-30 and screen like BRCA
65
what is the mc electrolyte abnormality in SBO
mechs?
so what type of fluid are you giving
hypok hypo cl met alk
vomiting Cl and H leads to higher bicarb in blood
RAAS tries to retain H and drops K
LR balanced
65
MCC of intussusception in adults
Ca
66
4 common bugs in SB overgrowth
4 structures that predispose
streptococci, bacteroids, Escherichia coli, and lactobacillus.
blind loops, fistula, larg divert, stricture
67
what can be seen on cbc for SB overgrowth patients and why?
B12 deficiency due to bacteria overconsumption
68
testing for sb overgrowth
imaging?
labs?
A d-xylose test (carbohydrate breath test) is useful. The metabolism of carbohydrate substrates from bacteria leads to the production of hydrogen and/or methane, which is detected in the breath.
Cross-sectional imaging may serve to delineate anatomy if blind loops or strictures are present.
Laboratory findings include low vitamin B12, thiamine, and niacin levels, with high serum folate and vitamin K levels.
69
non op tx for sb overgrowth
MOA and duration
rifaximin
DNA dep RNA poly; 14 d
70
supplements for blind loop patients
B12 and med chain FA
71
2 most important surgical anatomy factors in optimizing short gut
how do these help
keeping IC valve and ileum
ICV allows for transit control
Ileum absorbs ADEK, B12 and bile acids; most adaptable
72
compare ileum and jejunum
73
4 instances of TPN failure in short gut
Parenteral nutrition–associated liver disease
Loss of central venous access (ie, loss of three to six central venous access sites in children or two to four central venous access sites in adults)
Recurrent catheter-related sepsis or a single episode of fungal sepsis
Recurrent bouts of severe dehydration or metabolic abnormalities
74
absolute contraindication to SB transplant
Active infection or malignancy
75
3 long term complications with short gut outside of intestine
Calcium oxalate kidney stones and gallstones
Hepatic and biliary disease
Metabolic bone disease
76
alternate PE findings for appendicitis
Rather, patients with a retrocecal appendix will often have a positive psoas sign (pain with active flexion of the right hip), whereas patients with a pelvic appendix will often have a positive obturator sign (pain with passive adduction of a flexed right hip).
77
For appy, what causes luminal obstruction in kids v adults
MALT v fecelith
78
median age of appendicitis
28
79
assoc disease with appy
CF
80
Appy ddg in women
pelvic inflammatory disease, adnexal cysts, ovarian torsion, ectopic pregnancy, or a tubo-ovarian abscess should be considered.
81
percent of pop with appy
6%
82
All the appy PE signs
83
negative appy risk for pregnancy
Negative appendectomy is associated with a 4% rate of fetal loss and a 10% rate of early delivery.
84
considerations in interval appy
An underlying mass should be excluded with colonoscopy in appropriate patients.
Delayed appendectomies are recommended for two reasons: to prevent the recurrence of appendicitis and to exclude neoplasms within the appendix or cecum.
The incidence of appendiceal neoplasms at appendectomy is approximately 1% to 1.5% and increases after age 40. This risk should be weighed when considering interval appendectomy.
85
Lap appy risk %s
Patients undergoing laparoscopic appendectomies have a 1.2% chance of requiring conversion to open operation, a 0.7% risk for intraoperative complications, and a 1.5% risk for postoperative complications.
86
Describe toxigenesis of C diff
Toxigenic strains produce two toxins, A and B, which cause mucosal injury and increased fluid secretion from colonic enterocytes, in turn causing the characteristic watery diarrhea seen in active infection. Toxin B is more than 10 times as potent as toxin A.
Localized necrosis of the mucosa and the subsequent inflammatory cascade lead to the formation of pseudomembranes on the mucosal surface, which are localized collections of cellular inflammatory debris.
87
What hx should be asked if concern for c diff
Workup for C difficile colitis is indicated for patients with clinically significant watery diarrhea (>3 episodes in 24 hours), recent antibiotic use (most commonly within 2 weeks prior to the onset of symptoms), recent hospitalization or residence in a health care facility, or a known history of C difficile infection.
88
first line test for c diff; whats the issue
next?
stool toxin, false negatives
NAAT --- looks for gene encoding toxin B
89
concerning colonic measurements in c diff
colon> 6cm
cecum>12
90
2 labs for severe c diff
15k wbc or 1.5 cr
91
what may be a harbringer of worsening c diff colitis?
this is secondary to....
worsening ileus; colonic atony
92
mortality and stoma reversal rates with c diff colectomy
preferred operation?
Mortality rates for C difficile colitis requiring surgery are greater than 50%.
Stoma reversal rates are less than 35%.
total
93
recurrent c diff recs: 1st 2nd 3rd
For the first recurrence: pulse-tapered oral vancomycin or oral fidaxomicin is indicated if the infection was initially treated with vancomycin. If it was initially treated with fidaxomicin or metronidazole, oral vancomycin is indicated.
For the second recurrence: longer courses of vancomycin, fidaxomicin, rifaximin, and/or combinations thereof are indicated.
Consider fecal microbiota transplant in patients with multiple recurrent C difficile infections despite multiple rounds of adequate therapy.
94
inpatient acute c diff colitis mild, severe and fulminant medical txs
what if ileus is present?
mild: oral vanc or fidaxomycin
sev: same
fulm: oral vanc and IV metro
rectal vanc enemas for ileus
95
tracking for C diff incidence
The Centers for Medicare & Medicaid Services requires that all acute care hospitals, long-term care facilities, and inpatient rehabilitation facilities report C difficile infections via the National Healthcare Safety Network run by the Centers for Disease Control and Prevention.
Laboratory-positive infections must be reported, as well as the patient’s location at the time of positive specimen collection. Data are collected from inpatient units, emergency departments, and 24-hour observation units (ie, clinical decision units).
96
What therapy is given after all mastectomies and lumpectomies?
What are the benefits?
WB rads
dec local rec
inc survival
97
4 patients that cant get breast cons therapy for DCIS
1st tri preg
diff pos margins
small breasts
diffuse susp calcs
98
MC complication of PEG tube
infection
99
Tx for any solid intratesticular mass?
radical orchiectomy
100
What are the 3 antigen presenting cells and which one predominates
Dendritic
mp, B cell
101
kupffer cells
liver Mps
102
NK cells attack cells that lack what
MHC1
103
IL for B cells
4
104
Reboa zones and where not to occlude
105
Single bx for barretts confirms high grade, what now
tx
4 quad bx every 1 cm
EMR
106
MCCx of hemorrhoidectomy and why
urinary incontince
-ivf
-pain irritating nerves
-adv age
107
Signs concerning for primary graft non function for liver tx
tx
re trans
108
First line tx for acute rejection of transplant
2nd?
steroids
anti-thymocyte globulin
109
Mondor dis primary cause
secondary?
idiopathic
trauma, iatrogenic, infection, ca, hypercoag, vasculitis
110
MCC of suppurative jugular vein thrombo
pharyngitis
111
Dg imaging for colovesical fistula
CT
112
MC side of dissection in type B
posterolateral
113
Gastric NET endoscopic resection cutoff?
2cm as 10% nodal mets at that point
114
tracheal injury mng:
1. small anterior defects
2. transection(howmany rings can be lost?)
3trach?
1. simple transverse
2. 6
3. Devastating injury
115
positive predictors for successful reflux surgery
typical gerd signs
demeester appropriate
good response to ppi
116
ca in celiac patients
enteropathy assoc t cell lymphoma
117
MCC of liver failure in US?
tx?
acetam
n-acetyl
118
do i have to tell patients im HIV pos?
not legally, but ethically
119
MC long term sequelae of ileal pouch
pouchitis
120
preferred graft type in sma bypass
PTFE
121
measurement cutoffs for arteries and veins for fistula formation wrist?
upper arm?
2mm artery and 2-3mm veins
3?
122
rule of 6s for av fistula formation
123
When can a pregnant woman get rads for breast ca?
what would she receive otherwise if operative
2nd and 3rd
simple mastectomy and SLNB
124
What is the proven benefit of a trach
less sedation to aid in weaning
125
3 mechs of PTH ca inc
1. osteoclast stim
2. stim calcitriol(VD) formation
3. DCT rabsorb in kidney
126
3 MC bugs in SBT
e coli, kleb, pneumococc
127
Most important vitamin in wound healing
3 mechs
collagen cross linking
makes hydroxyproline
stabilizes collagen
128
what is a positive apnea test?
pCO2 rises to 60 off vent
129
combined invasice breast ca and DCIS tumor margin rules
negative ink is good
130
why 2mm for DCIS
skip lesion
131
location for thoracentesis
8th midax and mid scap
132
In patients with hematochezia and hypotn what must be ruled out
UGIB
133
absolute indications for dialysis
relative?
uremic pericarditis, pleuritis, encephalopathy
AEIOU
134
mid shaft humoral fracture is associated with what nerve injury
radial
135
radial , median and ulnar distal ue motor actions?
radial - thumb and wrist ext
median thumb and wrist flex
ulnar - all pinky stuff
136
early vs late graft infection bugs
aureus vs epidermidis
137
2 parts of treatment for TTP?
steroids and plasmapheresis
give new ADAMTS3 while suppressing further destruction by immune system
138
2 GIST grade determinants
139
when should warfarin be bridged for surgery concerning AF stroke risk
what trial supports this
CHADSVASC of 3
BRIDGE trial
140
MCC hepatits in west vs east
Western is B
Eastern is C
141
Do any superficial vein thrombi need anticoag?
3 cm from saphenousfemoral junction
142
epithelial ovarian tumor marker
CA 125
143
MCC of liver failure in
US v world
acetam vs viral
144
prosthetic vs mechanical benefit
downside
MCC of death for both
no long term anticoag
dont last as long
CHF
145
4 genetic syndromes involving PNETs
VHL, MEN1, NF1, tuberous sclerosis
146
dominant cell type in proliverative phase
fibroblasts
147
what is the max tensile strength after wound healing
80% at 6 weeks
148
what effect do myofibroblasts have on wound
contraction
149
MCCx of ERCP
pancreatitis
150
MC site of renal mets
lung
151
3 high risk CV surgeries; overall % risk
aortic, major vasc, periph vasc
>5
152
Which toxin for C diff causes intestinal necrosis
A
153
lymphangitis abx?
clindamycon
154
3 expected lab findings post splenectomy
mild leuko
thrombocytosis
howell jolly and targets
155
critical limb ischemia ABI
0.5
156
When to perform endoscopic ultrasound for panc cyst?
157
large symptomatic splenic cyst treatment? size cutoff
surgery
5cm
158
what would keep one from doing combined liver and colon resections?
symptomatic, multi segmental, or complex rectal surgery
159
3 risk factors for spontaneous retroperitioneal hemorrhage
old, antiplatelet and renal impairment
160
What is the borderline gallbladder polyp size and when should this class be removed?
What size always comes out
Symptomatic or high risk:older than 50, primary sclerosing cholangitis, Indian ethnicity, and the presence of a sessile polyp (including focal wall thickening >4 mm).
10mm
161
complete surgical management of gallstone ileus?
ONLY enterostomy
162
what is the benefit of lap vs open inguinal for cirrhotic patients
less bleeding
163
Go to surgery for femoral hernia repair if able to reduce
lap
164
What should you do for a preg lady with symp stones recurring in the 3rd trimester
operate
165
IVF strategy for pyloric stenosis baby
f the initial chloride is less than 97 mmol/L but greater than 85 mmol/L, 2 boluses of 20 mL/kg of normal saline are administered. If the chloride is less than 85 mmol/L, 3 subsequent boluses of 20 mL/kg are given. Each of the boluses is separated by 1 hour to allow for tissue rehydration without causing unnecessary diuresis from rapid intravascular expansion. Serum electrolytes are then repeated after the requisite number of boluses are given. During ongoing bolus fluid resuscitation, maintenance fluid is administered. In addition to boluses of normal saline, depending on the degree of hypochloremia, the appropriate maintenance fluid to administer to this patient is 5% dextrose in 0.45% normal saline.
needs K too
166
Size cutoffs for pyloric stenosis
3mm and 15mm
167
2 required investigations prior to fundo for GERD
what is accessory if above positive for gerd
EGD and manometry
ph test
168
Thiamine deficiency s/s?
B12?
Thiamine deficiency, or beriberi, can present in 2 forms. “Wet” beriberi can present with tachycardia, right heart failure and respiratory symptoms, hypertension, and vasodilatory edema. “Dry” beriberi, which is more common, presents with predominant neurologic manifestations. These include lower extremity neuropathy, myalgia, atrophy, and paraplegia in severe forms.
peripheral neuropathy and megoblastic anemia
169
If a roux comes in with tachycardia.....
explore!
170
Tx for ilecolic anastomosis stricture in crohns
dilation
171
next step for esoph adeno if mass cant be traversed with scop
PET/CT
172
screening guidelines for barretts
Gastroenterology guidelines recommend screening for Barrett esophagus in men with chronic (>5 years) or frequent heartburn/acid regurgitation who have 2 or more additional risk factors (age >50, current smoker or history of smoking, central obesity, family history of Barrett esophagus, or esophageal adenocarcinoma in a first-degree relative).
173
surveillance sched:
barretts
lgd
hgd
3-5y
1y or ablation
EMR
174
HGD barretts ca risk annually
7%
175
only thing that improves lap insufflation pain
lower pressure
176
duodenal polyp findings and improtance for risk
177
Extremely dense breast tissue is a ___ relative risk for breast cancer in this age group
2
40-49
178
what lifetime risk indicates annual MRI for breast cancer?
20%
179
preferred imaging modality for neoadjuvant follow up for breast cancer
mri
180
higher incidence of what comparing autologous to implants for breast rocon
periop complications
181
calcification descriptions and their risk %:
rim -
linear
round -
dystrophic
rim - <2
linear -2-95 (78)
round - <2
dystrophic -<2
182
4 high risk calcification appearances
linear, pleiomorphic, coars heterog, amorphous
183
benign sounding calcifications
Round-shaped calcifications and rim calcifications are classified as typically benign with less than 2% risk of malignancy. The fifth edition combined eggshell and lucent-centered calcifications into rim calcifications. Additionally probably benign calcification descriptors include large rod-like, coarse, “popcorn like,” vascular, dystrophic, and milk of calcium.
184
granulomatous mastitis tx
steroids or MTX if needed
185
indications for genetic testing for breast cancer
186
stromal fibrosis on core needle in breast, next step if concordant with rads
follow up imaging
187
`follow up after stage 2 breast full treatment
annual mammogram
188
screening sched for brca
annual MRI at 25 and mammos plus mri at 30
rec BSO
+/- bpm
189
what receptor status is eligible for gene expression assay in breast
what is this hlepful for
ER+
adj chemo decisions
190
How to fundo a sleeve
Hill esophagogastropexy -- lesser curve to MAL
191
highest risk post transplant ca
SCC of skin
192
When to do Delorme
small less than 5cm without strangulation
193
on what aspects of the arm are fasciotomies performed, what structure is included
volar and dorsal with carpal tunnel release
194
4 TASC c lesions
195
most common site of CRC recurrenc ranked
liver, lung, local
196
Go to HIPEC drug
MOA
mytomycin
crosslinks--damages DNA syynth
197
what is the new tissue involvement for stage 3 sacral ulcer
subcut fat
198
first step in colonic pseudo obstruction workup after CT
Tx
barium enema
neo
199
most sensitive imagin modality to detect small liver mets
IO u/s
200
Explain TBI categories
201
associate vit deficiency 2/2 carcinoid syndrome consumption of tryptophan
s/s?
B3 - niacin
derm, dem, diarrhea
202
what is recycled in the Cori cycle
what metabolic state is the patient in
lactate and pyruvate to glucose
starvation
203
Newest rec for peds bleeding diverticula?
exceptions?
neoplasm, ischemia, or wide base
204
heller myotomy rule
5 up 2 down
205
what causes skin changes in inflam breast ca
tumor cells in lymphatics
206
When does the radical cholec upgrade given T stage and what to
T3 through serosa
needs full segmental 4b 5
207
inc ICP triad
2 accessory symptoms
cushings: bradycardia, resp depress, htn
6th crania nerve palsy -- lateral rectus weakening blurry vision
pain
208
bladder pressure for ACS
20
209
peripheral nodular enhancement in liver imaging means
hemangioma
210
Differnetiate the CT findings for benign liver tumors
211
next step for panc fistula if output persists
stent and sphincterotomy
212
risk of strangulation for femoral hernia
45%
213
MC STV in US
condyloma accuminata
214
what is the known benefit of closing fascia for laparoscopic hernia repair
seroma dec
215
severe short bowel medication and effects
GLP2 -- mucosal growth
216
imaging for breast mass in man
u/s and mammo
217
MCC of goiter and hypothyroidism>, also called
abs?
Hashimoto -chronic lymphocytic thyroiditis
thyroid peroxidase ab, throglobulin abs
218
MC site for GI NET? followed by....
rectum then SB(ileum)
219
MC panc adeno oncogene
KRAS
220
what thyroid cancer spreads hematogenously
follicular
221
Nigro protocol total duration? What happens at the end?
12 weeks then re eval
if persistent then re eval in 4 then 3m
if progress APR
if remission then q3 m DRE
will then make operative decision
222
What causes amaurosis fugax in carotid stenosis
opthalmic artery blockage on same side
223
When can spleen be preserved with pancreatic cancer?
low risk tumors, NOT adeno
224
MEN 2 A components
oncogene
primary hyperthyroid
pheo
medullary
RET
225
N2 colorectal
4 or greater nodes
226
MArgins for Phyllodes
1cm
227
medial pectoral nerve innervates...
lateral?
both
pec major
228
MC undelying mass for bloody nipple discharge
intraductal papillomas -- excise them
229
MCC of OPSI
strep pneum
230
5 melanoma bx markers
HMB
Malan A
SOX10
MITF
S100
231
drainage amount throshold for biloma ERCP and stent
300cc/d
232
ALH lifetime risk inc
4 fold
233
pre op ekg algorithm
234
3 meds that can cause gynecomastis
dig, theoph, and tiazide
235
MCC of massive hemothorax
mortality per repair type?
lung laceration
236
dg of gastric band erosion stable v unstable
endo
ugi
237
ovarian vein thrombosis tx
anticoag, abx
238
preferred pregnant or malignancy induced dvt tx
NOAC cxs? relative?
lovenox
child c, breast feeding
renal, sev obese, child a or b
239
what was the suture size in STITCH
2-0
240
olaparib is rec for what cancer
TNBC wutg BRCA
241
MC minor salivary tumor/
malign rate?
where?
adenoid cystic
high
hard palate
242
duration of provoked dvt tx
3m
243
what dens fracture needs operation
Type 2
244
histology descriptions of radial scar, inflam bc, pagets eczema, and phyllodes
245
5 half lives of a drug is now at what % of the final steady state
97%
246
inheritance pattterns of Menin and RET
AD
247
ADEK deficiency effects
248
SE deficiency
cardiomyopathy
249
Zn deficiency
growth fail, skin lesions
250
hypo phos
bone pain
251
Cu deficiency(5)
anemia, neutropenia, pigmentation, arrythmias, bone
252
Chromium deficiency
diabetes like
253
mc adrenal met
lung
254
MC presentation of primary hyperaldosteronism
bilateral hyperplasia
255
blair incision
256
posterior hip dislocation associated injury
sciatic
257
Appy carcinoid rules
258
MCC of upper lip v lower
basal
squamous
259
what big part of an sma embolism ex lap go first
revasc
260
first step in looking for accessory spleen
sulfur colloid
261
histologic description of fibromuscular dysplasia
thickening of media with collagen formation
262
tamoxifen actions
estrogen antagonist but agonist in all other tissues
leads to DVt and endometriosis
263
meperidine SE
seizures
264
internal mammary artery is a branch of the _____
subclavian
265
hydrofluric acid burns are treated with ______
calcium
266
watery diarrheal metabolic acidosis make up
hypochloremic and hypokalemic
267
when to pre-emptively band varices
>5mm in Child B or C
268
biliary obstruction effects what vitamins
ADEK
269
Ketamine dosing
0.5-1 mg/kg -- analgesic
1-2 --- sedation
270
Now the preferred method for retained foreign body check
wand
271
Go to STSG donor site dressing
WET
272
current state of TXA
within one hour for GCS 15-9
or prehospital severe
no increase in DVT
273
What is TRALI similar to? how are they different
TRALI v TACO
ARDS, timing
pulmonary vs cardiogenic overload
274
what is the overall message with DECRA vs RESCUEicp
3 v 10 days refractory icps
late tx with decompressive craniotomy is better
275
go to dg modality for depth of injury after caustic ingestion
CT
276
what are the CT findings for adrenal carcinoma
overall mng?
what is a high risk lesion
houndsfields greater than 10 and less than 40% washout
surgery then adjuvant if high risk with mitotane
tumor spillage, ki67>10, mitotic >20 per 50
277
adjuvant therapy for adrenal Ca
mitotane
278
tx of fistula with minor sphincter involvement
fistulotomy primary
279
causes of end tidal CO2 drop intraop
PE
MI
technical
bronchospasm
280
risk for TRAM flap-
obesity
281
best pos prognosticator with CRC w/ liver mets
response to neo
282
VTE regimen for colorectal ca post op patients
4week
283
what is a striking feature of this abscess
amaebic abscess if hx fits
simple septation
284
milrinone moa
PDE 3 --- inc cardiac contractility
285
Endo AAA repair sizing rules:
prox neck length and diam
iliac landinzone and diam
take off angle
15mm; 17-32mm
20mm; 7-20
60 degrees
286
Treatment of LAMN with mucin pooling after appy
go straight to debulkign and hipec, no right hemi
287
fecal dna test needs to be done how often
3y
288
Haggit classification is irrelevent if ......
what is the Haggit classification at which formal resection is indicated
poor diff, high grade, LV invasion, PN invasion
4-- bowel wall submucosa
289
Sessile polyp classes and which one can be watched
SM1 with less than 50% horizontal spread ---- no high risk features
290
always do this after resection of small gastric polpys
get bx of normal tissue in several spots
291
Shallow anorectal fistula management
primary fistulecotmy
292
what is mechanical bowel prep good for
air leak test?
SSI
anastomotic leak
293
worst prognostic factor for gastric adeno
proximal location, increased depth and nodes
294
MLH1 and PMS2 + BRAF =
sporadic CRC
295
bad size and bad depth for rectal NET
what is this T stage usually
2cm; MP
T2
296
treatment for post hiatal hernia repair GOO due to vagal nerve injury
per oral pyloromyotomy
297
colonic lymphoma managment
surgery the CHOP
298
GIST vs leiomyom vs NET histo
when would we need to differentiate these
c Kit
Spindle with desmin
spindle without desmin
SM mass in rectum or esophagus
299
Layers of the esophagus and treatments per the level of esoph adeno involved
muc -EMR or esoph
sm - esoph
musc - neo and esoph
300
internal anal sphincter vs ext location
301
GS for esoph nodal staging
us
302
MC type of intussuseption
ileocolic then ileoileocolic
303
where does the lateral PJ for a peustow end?
start of head to tail
304
when can a fem pseudo be obs
less than 2cm
305
what is the new parkland formula
target uop in peds v adults
Brooks 2 instead of 4 x % x /mlkg
1/2 first 8h then 1/2 16 h
0.5-1 vs 1-1.5
306
mc met site for phyllodes
lung
307
mc sign for endometrial ca
demo?
vaginal bleeding
308
marasmus?
diff with kwashiorka?
total calorie proetein wasting
no edema or ansarca
309
when are thyroidectomies in the MEN classes now
2A - 5y
2B -1y
310
What is the only cdiff operation
total w/ end
311
80% of polyp will take this long to turn into CRC
What type are the other percent and what gene is involved
10y
sessile serrated, BRAF
312
time limit for thrombosed hemorrhoid excision
48h
313
rectal net size and layer cutoff for LAR
2cm, SM
314
anal squamous cell ca virus
hpv16
315
surveillance colonoscopy guidelines
316
4 pos indicators for pos margins in stomach adeno
>5cm, signet cells, adv T stage, prox location
317
if CT not confirmatory for CRC met then what is next
MRI
318
rec for uncomplicated divericulitis in transplant patients
rec for low dose steroid CR anastomosis in post transplant
obs
ok to do
319
What is the pref op for dysplasia found in a long time UC pt
what would alter this course and how
total procto
total abdominal alone if malnutrition or severe illness present
320
benefit of total neoadjuvant for rectal vs neo and adj
less toxicity
321
who gets neo for rectal ca
what defines stage 2
stage 2 and up
past the MP to mesorectal land
322
does perforation matter if all other characteristics are ok for appendiceal carcinoid
na dawg
323
what does basal cell look like
324
MC skin cancer
basal cell
325
Precursor lesion for second most common skin cancer
actinic keratosis
326
neuroendocrine cell skin cancer
how to stage
how to treat
Merkel cell
PET
WLE w/ SLNB
327
excisional margins for non melanoma cancers
4-10mm margins
328
scc on burn
marjolin ulcer
329
merkel cell margins
adjuvant
1-2cm
rads
330
merkel cell pic
331
subungal melanoma tx
SLNB?
amputation
yes if greater than 1mm depth
332
lymphangitis bug
strep pyogenes
333
fournier
ecoli, entero, kleb
334
concerning signs of soft tissue mass malignancy
fixed mass, painful mass, increased size (> 3 cm), and depth of mass within the extremity compartment
335
desmoid recurrence rate
50%
336
what sarcomas get rads?
adj chemo?
5cm, high grade
stage 3 pelvic/rp
337
pediatric blood bolus calculation
10-20 ml/kg
338
carboxyhb tx
high flow oxygen
339
bacitracin use?
SE?
2nd degree
nephro
340
mupirocin?
SE?
staph infection
irritaiton
341
silver sulffadizaine
SE
third deg bruns with gram neg coverage
neutropenia and thrombocytopenia
342
mafenide
3rd deg; pseudo, eschar
met acidosis
343
silver nitrate SEs
cx in ..
methhemoglobinemia, hyponatremia/cl/k/ca
g6pd def
344
hypothermia classes and treattment
345
frostbite initial treatment
warm body, warm water, drain clear blisters
346
skin graft type for joints
full thickness
347
malignant bowel obstruction alternative from surgery
decompressive G tube
348
which is the mens BRCA
2
349
what anal fissure medication causes headaches
nitrates
350
preferred flap for irradiated APR defect
RAM flap
351
hawthorne bias
they know they are observed
352
berkson bias
chosen population is not generalized(only inpatient for ecample)
353
pygmalion effect
researcher opinion bias
354
paired v unpaired test
2 groups
before and after one treatment
2 separate txs
355
chi square?
2 groups categorical outcomes
356
ANOVA?
before and after continuous with more than 2 groups
