TrueLearn Flashcards

(226 cards)

1
Q

Explain the maneuver:
Mattox
Cattell Brasch

A

Mattox: left medial-visceral rotation

Cattell Brasch: right colon mobilization

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2
Q

Amino acid associated with T cell stimulation

A

Arginine

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3
Q

Radiotracer or methylene blue for SLNB in pregnancy

A

Radiotracer (meth blue is teratogen)

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4
Q

Dysplastic changes of basal layer of skin, parakeratosis, dermal solar elastosis

A

Actinic keratosis (pre-SCC)

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5
Q

Dx of biliary dyskinesia on CCK HIDA

A

EF <35% at 20 min

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6
Q

Central line type associated with lowest DVT and line infection

A

Subclavian

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7
Q

Intestinal hamartoma
Hyperpigmented oral lesions
Breast, cervical, thyroid, lung ca

A

Peutz Jeghers

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8
Q

Associated tumor marker:

  • Embryonal cell ca, ovarian chorioca, mixed germ cell
  • Yolk sac, embryonal cell, immature teratoma
  • Dysgerminoma
  • Granulosa cell
A
  • Embryonal cell ca, ovarian chorioca, mixed germ cell: HCG
  • Yolk sac, embryonal cell, immature teratoma: AFP
  • Dysgerminoma: LDH
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9
Q

Gastrinoma: M or F predominant?

A

Male 2:1

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10
Q

Contraindication to nitrous oxide

A

SBO (air filled cavities)

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11
Q

Acid-base dx after pancreas txp

A

Met acidosis from HCO3 losses in pancreatic secretions

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12
Q

When in gestation does alveolar phase of development begin

A

7 months

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13
Q

Phyllodes margin and recurrence rate

A

1-2 cm margins

20% recurrence

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14
Q

First step in massive hemoptysis

A

Rigid bronch and packing

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15
Q

ID the liver lesion:

  • Homogenous enhancement of hypodense lesion with central scar
  • Heterogenous mass with arterial phase enhancement
  • Low density and peripheral nodular enhancement
A
  • Homogenous enhancement of hypodense lesion with central scar: FNH
  • Heterogenous mass with arterial phase enhancement: adenoma
  • Low density and peripheral nodular enhancement: hemangioma
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16
Q

Child’s scores and corresponding surgery mortality

A

A: 5-6 points -> 10% mortality
B: 7-9 -> 30%
C: 10-15 -> 80%

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17
Q

Preop medical tx of adrenal aldo-secreting tumor

A

Spironolactone/eplerenone and K+

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18
Q

Tx of Frey Syndrome

A

Antiperspirant application to affected skin

If refractory -> tympanic neurectomy

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19
Q

Best route for esophageal substitution

A

Posterior mediastinum

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20
Q

Reason for urinary retention acutely post-hemorrhoidectomy

A

Pelvic floor muscle spasm

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21
Q

Mechanism by which hypomagnesemia results in hypocalcemia (2)

A
  • Impaired PTH release

- Impaired PTH receptor sensitivity

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22
Q

Immediate tx for ABO incompatible blood transfusion

A

Stop transfusion

Large volume fluid resusc

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23
Q

Two genes associated with HNPCC

A

MSH2, MLH1

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24
Q

Workup of bile reflux gastritis after Billroth

A

EGD and [bile] in gastric secretions OR HIDA

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25
Minimum roux limb length in ReY gastrojejunostomy to avoid bile reflux
45 cm
26
Types A and B aneurysm size criteria for repair
Type A: >=5.5 cm | Type B: >=6.5 cm
27
Most common source of zone III trauma bleeding
Sacral venous plexus
28
Indications for radical neck dissection for parotid tumours
High grade malignant tumours (mucoepidermoid, squamous cell), even if clinically N0
29
Antidote for ethylene glycol poisoning
Fomepizole
30
How to manage clinically positive nodes in melanoma
FNA -> equivocal -> excisional bx
31
Criteria for surgery for intussusception
Necrotic bowel, 2+ recurrences, incomplete reduction | Squeeze mass distal to proximal
32
``` Secretin stimulation study: Total volume Enzyme level HCO3 - ZES, malnutrition, chronic pancreatitis, cancer, end-stage pancreatitis ```
ZES: High volume; normal enzyme, HCO3 Malnutrition: Decreased enzyme; normal volume, HCO3 Chronic panc: Low HCO3; normal enzyme, volume Cancer: Low volume; normal enzyme, HCO3 End stage pancreatitis: Low volume, enzyme, HCO3
33
Most common site of traction esophageal diverticuli
Mid esophagus
34
How to do a Puestow
Open duct anteriorly, extend medially to level of GDA, and laterally past all strictures
35
Tx of LCIS
Excisional bx -> close observation, tamoxifen, or prophylactic bilat mastectomy
36
Most common presentation for lap band erosion
port site infection
37
RFs for gastric polyps (2)
Atrophic gastritis and H. pylori
38
TIPS one-year shunt re-stenosis rate
50%
39
Most common cause of dysphagia immediately s/p Nissen
Edema; should resolve in 6-8 weeks
40
Three stages of skin graft survival in recipient site
Imbibition -> inosculation -> angiogenesis
41
Best patency after angioplasty (artery)
iliac
42
Indication for liver txp for hilar cholangioca
N0 and M0 unresectable dx
43
Rule of 6s for AVFs
blood flow >600 mL/min diameter >0.6 cm depth 0.6 cm
44
Aberrant anatomy to consider when dividing gastrohepatic ligament in Nissen
Replaced left hepatic coming from L gastric
45
Most common site of SB lymphoma
Ileum
46
Splenic laceration grading (AAST)
1: subcapsular hematoma <10% of surface area parenchymal laceration <1 cm depth 2: subcapsular hematoma 10-50% of surface area intraparenchymal hematoma <5 cm parenchymal laceration 1-3 cm in depth 3: subcapsular hematoma >50% of surface area ruptured subcapsular or intraparenchymal hematoma ≥5 cm parenchymal laceration >3 cm in depth 4: any injury in the presence of a splenic vascular injury* or active bleeding confined within splenic capsule parenchymal laceration involving segmental or hilar vessels producing >25% devascularisation 5: shattered spleen any injury in the presence of splenic vascular injury* with active bleeding extending beyond the spleen into the peritoneum
47
When to resume physical activity after splenic trauma?
Grade + 2 weeks
48
Most common cause of AVF thrombosis
Intimal hyperplasia of venous anastomosis
49
Which component of GCS is most sensitive to neurotrauma
Motor
50
Type of salivary gland tumor with propensity to metastasize along nerves
Adenoid cystic
51
Agents that increase or decrease LES tone
Increase LES: gastrin, motilin | Decrease: secretin, CCK, estrogen, progesterone, somatostatin
52
Most prevalent organism in non-aneurysmal aortic infection
Salmonella
53
Early vs. interval appy
``` Early: Early return to work Increased complications (SBO, reoperation, wound infection) ```
54
Tx of solitary rectal ulcer syndrome
Conservative: high fiber, biofeedback
55
Mechanism of diverticular bleed
Rupture of vasa recta
56
Most devastating cause of PONV following sleeve gastrectomy
Portomesenteric venous thrombosis
57
Longest phase of the cell cycle
G1 (11 h)
58
Pharmacokinetics vs. pharmacodynamics
PK: What happens to a drug in the body PD: What the drug does to the body
59
Orlistat
Anti-obesity agent that inhibits GI lipases and decreases fat absorption
60
Cancer associated with vinyl chloride
Hepatic angiosa
61
When to do classic Whipple (+antrectomy) vs. pylorus-preserving Whipple
Classic when D1 involved
62
``` Common burn meds ADR: AgNO3 Ag sulfadiazene Mafenide acetate Neomycin/baci/polymyxin B ```
AgNO3: hyponatremia Ag sulfadiazene: neutropenia Mafenide acetate: met acidosis Neomycin/baci/polymyxin B: nephrotoxic
63
Zn deficiency signs (3)
Impaired wound healing FTT Rash
64
Selenium deficiency signs (3)
Cardiomyopathy Hypothyroidism Neuro changes
65
Initial step in improving hypotension in pregnant trauma
Roll to the left (uterus rolls off the IVC)
66
What group of cells stimulates fibroblasts in wound healing
Macrophages
67
``` % weight loss after Lap band Sleeve Bypass Switch ```
Lap band 40-55% Sleeve 54-70% Bypass 60% Switch 70%
68
First line tx of stage 4 RCC
Sunitinib, panzopanib
69
Tx for parotid tumours if - Benign (warthin, pleomorphic) - Malignant (mucoepidermoid, adenoid cystic)
- Benign (warthin, pleomorphic): WLE | - Malignant (mucoepidermoid, adenoid cystic): total parotidectomy, MRND, XRT
70
Melanoma subtypes with worst and best prognosis
Worst: nodular Best: lentigo maligna
71
Cationic trypsinogen gene mutation
Hereditary pancreatitis (PRSS1)
72
High risk features of BCC/SCC warranting Mohs
``` Poorly differentiated Face, genitalia, hands/feet >=6mm Depth >=4 mm PN invasion Immunosuppression Marjolin ulcer ```
73
First step if gastric conduit does not reach esophagus
Kocher
74
Signs of contrast nephropathy
``` Normal UOP SCr >25% elevated Muddy brown casts FeNa <1 Mild proteinuria ```
75
Most common gene mutation in pancreatic cancer
K-ras
76
Most common complication of I and D
bleeding
77
Diagnosis of melanoma (what kind of bx)
Must be full thickness bx
78
Margins for melanoma WLE
is: 0.5-1 cm <1 mm: 1 cm 1-2 mm: 1-2 cm >2 mm: >=2 cm
79
Where should you not place tacks in IHR
Inferior to iliopubic tract and lateral to epigastrics (neurovascular injury)
80
Best tx for low grade gastric MALT
Abx for hP
81
Tx for gastric band slippage
Concern for ischemia so immediately remove saline from band and go to OR for band removal
82
Only effective chemo for HCC
Sorafenib (VEGF inhibitor)
83
Milan criteria for resectable HCC (3)
<5 cm lesion <=3 lesions each smaller than 3 cm No extrahepatic dx
84
Tx of asymptomatic histoplasmosis
Nothing
85
Bx margin for suspected melanoma
Full thickness bx with 1-2 mm margins
86
Goal lactate in resuscitation of trauma
<2.5
87
Which organism that causes PID is most associated with infertility
Chlamydia
88
Size at which adrenal masses should be resected
>6 cm
89
Tx for supracondylar humerus fx
Closed reduction with pin fixation
90
Most common organism in lymphangitis
Group A strep
91
For ITP splenectomy, when is plt transfusion given
Right after splenic artery ligation
92
% ICA stenosis at which to perform CEA
Sx: >50% Asx: >60%
93
Calcitonin effect on PO4
Promotes PO4 excretion
94
HCG criterion for MTX for ectopic pregnancy
HCG <=5000
95
Hepatoblastoma associated with which familial syndromes
``` Beckwith-Wiedmann Hemihypertrophy Li Fraumeni FAP T18 ```
96
% of total daily calories to be given as N2 in patients with malnutrition needing TPN
15%
97
Most anterior and posterior structures in porta hepatis
Anterior: artery Posterior: portal vein
98
``` Tx for choledochal cysts type: 1 2 3 4 ```
1/4: hepaticojej 2: Cyst excision, primary closure of CBD 3: ERCP marsupialization or transduodenal excision
99
Type of mesh to use in splenorrhaphy for trauma
Absorbable
100
Tx for recurrent anal canal SCC
APR
101
Respiratory quotient
CO2 produced/O2 consumed
102
Best operation for Crohn duodenal strictures causing obstructive sx
Gastrojejunostomy
103
Manometry findings for scleroderma esophageal dysmotility (amplitude, type of contractions, LES pressure)
Low amplitude Simultaneous contractions Normal/low LES pressure
104
Anterior to posterior thoracic outlet: scalene, axillary nerve, axillary vein, brachial plexus
Vein Muscle Artery Nerve
105
Tx of radial scar (breast)
Excisional bx
106
PE finding for obturator hernia
Medial thigh pain elicited by internal rotation and extension of thigh (Howship-Romberg sign)
107
What is the organ with the highest K secretion?
Colon
108
Dermatofibrosarcoma protuberans - Signs - Path - Tx
Firm, red plaques that resemble keloids Path: finger-like projection of spindle cells Tx: WLE w/ 2 cm margins or Mohs; adjuvant XRT if >5 cm
109
First step in evaluating bloody diarrhea s/p AAA repair
Sigmoidoscopy
110
Latent error
System defect that is insidious until a mistake is made
111
Tx of nitroprusside toxicity
Amyl nitrite
112
Criteria for transanal resection of rectal cancer: - Size - Location (cm from verge) - T grade - High risk features - % circumference involved
- Size < 3cm - Location (cm from verge) <8 cm - T1 - High risk features: no mucin, no LV involvement - % circumference involved: <30%
113
CN XI - Where does it exit - Which nerve roots - Muscles supplied
- Exits in jugular foramen - C1-5 - SCM, trapezius
114
Cell origin of GIST
Interstitial cells of Cajal
115
McVay repair
Approximate transversus abdominus to Cooper's ligament with relaxing incision on anterior rectus Good for emergent femoral hernia repair
116
Between which two abdominal muscle layers is mesh placed in Rives-Stoppa VHR
Between rectus muscle and posterior rectus sheath
117
Tx of unresectable hepatoblastoma
Neoadjuvant cisplatin -> try to make it resectable
118
Tx of multiloculated splenic abscess
Splenectomy
119
4 types of cholangiocarcinoma
1: common hepatic duct only 2: hepatic bifurcation 3: secondary hepatic ducts on one side 4: secondary hepatic ducts on both sides
120
Size of Zenker above which diverticulectomy is added to myotomy
>2 cm
121
Goal UOP in electrical burns
2 ml/kg/hr
122
Signs of cholestasis/bile leak after liver txp associated with what vascular condition?
Hepatic artery thrombus
123
Most common presenting symptom for pseudomyxoma peritonei
Widening abdominal girth
124
Tx for CIN 1 vs. CIN2-3
CIN1: Observation | CIN2-3: LEEP
125
Tx for simple intersphincteric fistula | What if sphincter involved?
Intersphincteric: fistulotomy | If significant sphincter involvement: seton
126
EKG findings in PE
S1Q3T3 | Anterior leads T wave inversion
127
What does NOT improve after colectomy for UC (2)
PSC | Ankylosing spondylitis
128
Initial workup of suspected gastroparesis
EGD -> gastric emptying study
129
Most common postop complication after kidney txp
PGD
130
Safest laparoscopic access in redo abdomen
Hasson
131
Hypothermia: Temp, sx? - Mild - Mod - Severe
Mild: 32-34 C; shivering, AMS, tachycardia Mod: 29-32 C; agitation, spasticity, afib, hypotension Severe: 21-29 C; prolonged QRS, osborn waves, flaccid, coma, vfib, death Profound: <21C; death
132
``` Energy in kcal/g for TPN Lipid Protein Oral carbs Dextrose ```
Lipid 9 Protein 4 Oral carbs 4 Dextrose 3.4
133
Risk factors for small bowel adenocarcinoma (4)
Crohns FAP HNPCC Celiac
134
Tx for gastric cardia >T2N0 cancer | Number of nodes?
Neoadjuvant chemo TOTAL gastrectomy (to get 5 cm margins) 15 nodes at least
135
Parastomal hernia - Best repair - What if other stoma-related problems?
- Lap repair w/ bio mesh | - If other problems, can just resite stoma and reinforce with bio mesh
136
Best test to assess for colovesical fistula
CT (air in bladder)
137
Criteria for neoadjuvant chemo for bladder cancer (2)
T3 or higher (extends into fat) | N+
138
Tx for positive SLNB in melanoma
Can do completion LNB OR observe (U/S q3-12 mos x 2-3 years)
139
Tx of F XI deficiency
FFP, NOT purified factor (thrombogenic)
140
Safest inhalation anesthetic for low EF
Nitrous oxide
141
Most common organism in early vs. late vascular graft infections
early: s. aureus late: s. epidermidis
142
Most potent stimulator of pancreatic enzymes vs. fluid/HCO3
Enzymes: cck | Fluid/HCO3: secretin
143
Most common malignant peds lung tumors
Pleuropulmonary blastoma #1 | Carcinoid
144
Time interval for operating on thrombosed hemorrhoids
Within 4 days of sx
145
Minimum diameter of vessel to use bipolar cautery
>=7mm
146
Tx for retrorectal masses
Always excise
147
Tx of echinococcus splenic cysts
Sterilize -> splenectomy
148
Size and chronicity criteria for conservative management of pancreatic pseudocysts
<6 cm and <6 weeks should be conservative management | Enlarging cysts and sx -> cystgastrostomy
149
Most common malignant tumor of appendix
Adenoca (carcinoids not always malignant...)
150
Two most common organisms in pyogenic liver abscess
Klebsiella, e. coli
151
Pancreatic cancer that is associated with ovarian stroma
Mucinous cystic
152
Where in posterior pituitary is ADH released
Supraoptic and paraventricular nuclei
153
Four RFs for gb cancer
Cholelithiasis Choledochal cysts Porcelain Polyps
154
Management algorithm for suspected perineal Paget
First CT abdomen and colonoscopy (50% occult cancer) | Then WLE w/ perianal bx
155
Most important predictor of survival for pancreatic cancer
T stage (also N stage)
156
Liver mass w/ central scar but normal AFP and high neurotensin
Fibrolamellar HCC
157
Most common and most favourable cholangioca type
Most common: Nodular | Most favourable: Papillary
158
CAH (21 hydroxylase def) - Na, K - Which steroid is high
- Low Na, high K | - 17 hydroxyprogesterone high
159
Most radiosensitive tumour
Seminoma
160
Tx for Merkel cell carcinoma
WLE, SLNB, adjuvant XRT
161
Type of EGD (rigid or flexible) for foreign body in esophagus
Flexible is good enough these days (need anesthesia for rigid)
162
Four poor prognostic factors for neuroblastoma
Age >1 High NSE (neuron specific enolase) High LDH N-myc amplification
163
Minimum artery and vein diameter for AVF creation
Artery > 2mm | Vein > 3mm
164
Succinylcholine - How is it eliminated - Three contraindications to use
- Pseudocholinesterase elimination | - Contraindications: Large burns, spinal cord injuries, renal failure
165
Which nondepolarizing muscle blocker is safe for anesthesia in renal and hepatic failure
Cistracurium (Hoffman degradation)
166
Dose of long and short acting insulin the day of surgery
Half of long acting and no short acting
167
Tx of superficial vs deep septic thrombophlebitis
Superficial: abx, vein excision Deep: abx, heparin
168
Tx for ruptured umbilical hernia associated with ascites
Urgent surgery
169
21 vs. 11 hydroxylase deficiency: Mineralocorticoid level K Na
In 11 hydroxylase def, MC level HIGH, K LOW, Na HIGH | In 21, MC level LOW, K HIGH, Na LOW
170
``` Sx of Anterior cord Central cord Posterior cord Brown Sequard Cauda equina ```
Anterior cord: no motor/pain/temp below level of injury; preserved proprioception, fine touch Central cord: upper extremity weakness > lower; sacral sensory sparing Posterior cord: loss of proprioception and vibration only Brown Sequard: ipsilateral loss of motor, contralateral loss of pain/temp Cauda equina: areflexive bowel/bladder
171
Most common site of minor salivary gland tumors
Palate
172
Bilateral parotid masses associated with smoking
Warthin tumors
173
Three strongest predictors of operative mortality after CABG
Redo CABG Prior heart surgery Low EF
174
Most common cancer of upper vs. lower lip
Upper: basal cell Lower: scc
175
Richter hernia
Contains antimesenteric side of bowel (high strangulation risk)
176
Most potent stimulator of bile secretion
Secretin
177
Algorithm of axillary adenocarcinoma with no known primary
Mammo/MRI -> whole body PET -> axillary dissection, chemo/endocrine, whole breast XRT
178
Depth criterion for SLNB in melanoma
>=0.75 mm (stage IB)
179
Estimate free H2O deficit
Weight x 0.6 x (Na-140/140)
180
Steroid of choice in acute adrenal insufficiency
IV dexamethasone
181
Margins for low risk basal cell carcinoma
0.3-0.5 cm
182
Most common cause of death in lung txp <1 year and >1 year
<1 year: infection | >1 year: chronic rejection
183
Most common cause of rectovaginal fistula
Obstetric trauma
184
Immunosuppressive med and ADRs: - Tacrolimus - Sirolimus - Thymoglobulin - Mycophenolate - Cyclosporine
- Tacrolimus: HTN - Sirolimus: poor wound healing - Thymoglobulin: fever, hypotension - Mycophenolate: diarrhea - Cyclosporine: gingival hyperplasia, hirsutism
185
Lipoprotein with highest concentration of cholesterol
LDL
186
Tx of bone spindle cell tumor (malignant fibrous histiocytoma)
Neoadj chemo -> WLE
187
MCC of portal venous thrombus in kids
Umbilical vein infection
188
F/U for nonfunctioning small adrenal masses
Imaging at 6, 12, 24 months | Annual hormone testing for four years
189
Management of indeterminate pathology after FNA of thyroid nodule
Repeat FNA
190
Most commonly injured nerve in lap IHR
Genitofemoral
191
Nodular lymphoid hyperplasia in SB and colon associated with what kind of diseases?
Immunosuppression
192
What is the function of protein C?
It deactivates fVa and fVIIIa by proteolysis
193
Tx for type II choledochal cyst
Cystectomy and primary CBD closure
194
Tx for trauma medial or lateral to the lateral canthus of the eye
Medial: can observe Lateral: must operate
195
FMD of the carotid | Imaging finding? Tx?
Imaging: beaded stenoses of carotid Tx: PTCA
196
INR vs. PTT: which represents extrinsic vs. intrinsic pathway?
INR: extrinsic PTT: intrinsic (does NOT measure F VII)
197
Max volume of air that can be expired after max inhalation
Vital capacity
198
In trauma laparotomy, order in which to pack: inframesocolic, supramesocolic, lesser sac, retroperitoneum
Inframesocolic -> supramesocolic -> RP -> lesser sac
199
Highest sensitivity initial test for pheo
Plasma free metanephrines
200
Decreased total exocrine secretion volume in pancreas
Pancreatic cancer
201
Decreased HCO3 secretion in pancreas
Chronic pancreatitis
202
Decreased pancreatic enzyme secretion
Malnutrition
203
Decreased volume, enzyme, and HCO3 from pancreas
End stage pancreatitis 'burnout'
204
Tx for cT1 vs. cT2 bladder cancer
T1: TURB + HCG | T2 (muscle invasive)+: Cystectomy, ileal conduit
205
Worrisome vs. high risk features for IPMN
Worrisome (EUS at least): Main duct 5-9 mm, change in duct caliber, adenopathy, pancreatitis, BD IPMN > 3 cm, mural nodules, thickened, enhancing wall High risk (resect): Main duct >1cm, enhancing solid component within cyst, jaundice
206
What cancer is CDH1 mutation associated with
Diffuse signet ring cell gastric cancer
207
Seven variables in Gail's model
Age Age at menarche Age at first child Family history of breast cancer (first degree) No. of past breast bx No. of past breast bx showing atypical hyperplasia Race/ethnicity
208
Which enzyme is cleared fastest in pancreatitis?
Amylase
209
Which pancreatic enzyme is secreted into the duct in its active form?
Lipase
210
Tx for low rectovaginal fistula
Endorectal advancement flap
211
Most common location for small bowel lymphoma
Ileum
212
Electrolyte abnormality associated with Sheehan syndrome
Hyponatremia
213
Teduglutide
GLP-2 agonist used in short bowel syndrome
214
Does right or left vagus become posterior? Which gives rise to hepatic branch? Grassi?
Right is posterior. Right: Grassi. Left: Hepatic
215
In Heller length of myotomy on esophagus and stomach
5-6 cm on esophagus; 2 cm on stomach
216
Two electrolyte imbalances associated with amphotericin B
Hypokalemia | Hypomagnesemia
217
Hypertriglyceridemia + hypercholesterolemia are a toxicity of this immunosuppressive medication
Sirolimus
218
How to calculate expected weight loss after bari surgery
(Current weight - ideal weight)*percent weight loss expected
219
Most common ectopic location of superior vs. inferior parathyroid gland
Superior: TE groove Inferior: thyrothymic ligament
220
1. First major steps in liver resection | 2. From anterior to posterior, structures in porta hepatis
1. Division of ligaments -> chole | 2. artery, portal vein, hepatic vein
221
Type of liver cells present in FNH
Kupffer cells
222
Signs of essential FA deficiency
Scaly rash Poor healing Sparse hair growth
223
Minimum liver remnant after resection (%)
20%
224
Most common cause of splenic injury during laparoscopy
Forceful retraction of omentum
225
Most common and favorable morphology of cholangio
Common: sclerosing Favorable: papillary
226
Initial and hourly chest tube output warranting thoracotomy following trauma
>1.5 L upfront | >200-300 mL/hr