Absite killer plus
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| What is the source of fever in atelectasis? | Alveolar macrophages
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| What is the first sign of malignant hyperthermia? | Increase in end-tidal CO2
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| What is the treatment for malignant hyperthermia | Dantrolene
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| What is the first muscle to recover from paralytics? | Diaphragm
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| What is the rate-limiting step in cholesterol formation? | HMG coA Reductase
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| Where is angiotensin I converted into angiotensin II? | lung
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| What are the effects of angiotensin II? | Vasoconstriction
Increases aldosterone (keeps Na, loses K/H in urine)
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| Describe the anatomy of the vagus innervation of the stomach | Left vagus (anterior) gives hepatic branch, Right (posterior) gives celiac branch and "criminal nerve of Grassi"
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| Which cells produce pepsinogen? | Chief cells
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| Which cells produce intrinsic factor? | Parietal cells
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| What are the main stimuli for H+ production in the stomach? | Acetylcholine, gastrin, and histamine
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| What is the mechanism of omeprazole? | Blocks H/K ATPase of parietal cell
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| What is the most common symptom post-vagotomy? | Diarrhea (35%)
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| What is the cause of early (15-30 min) dumping syndrome? | Hyperosmotic load, fluid shift causes neuroendocrine response, peripheral and splanchnic vasodilation
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| What is the cause of late (2-3 hrs) dumping syndrome? | Increased insulin with decreased glucose
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| What are the 3 actions of CCK? | 1) contract gallbladder
2) Relax Sphincter of Oddi
3) Increase pancreatic enzyme secretion
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| What is the primary stimulus of pancreatic bicarb secretion? | secretin
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| What affects the amount of bicarb in pancreatic secretions? | Flow rate: high flow = high bicarb, low Cl. Slow flow allows more HCO3/Cl exchange
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| Describe the phases of the migratory motor complex | Phase I - quiescence;
Phase II - acceleration, gallbladder contraction;
Phase III - peristalsis;
Phase IV - subsiding electric activity; occurs in 90 min cycles
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| What is the key stimulatory hormone of the MMC? | motilin
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| What drug stimulates motilin receptors? | Erythromycin
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| What is the action of Protein C and Protein S? | Protein C degrades active V and VIII. Protein S helps protein C
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| What is the only clotting factor not made in the liver? | Factor VIII (made by reticuloendothelial system)
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| What is the difference between the three types of Von Willebrand's Disease? | Type I and III have low amounts of vWF, respond to ddAVP
Type II is qualitatively poor vWF
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| What is the only inherited coagulopathy with long bleeding time? | Von Willebrand's Disease (autosomal dominant)
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| What is the pathophysiology of Glanzman's thombasthenia? | IIb/IIIa receptor deficiency of platelets. Decreased platelet aggregation. Fibrin normally links Gp IIb/IIIa receptors
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| What is the pathophysiology of Bernard Soulier syndrome? | Ib receptor deficiency of platelets. Decreased adherence of exposed collagen. vWF normally links Gp Ib to collagen
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| What test confirms the presence of von Willebrand Disease? | Ristocetin test
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| What are the three possible treatments for vWD? | DDAVP
Factor VIII
cryoprecipitate
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| What is the treatment for hemarthrosis in a hemophiliac? | Ice, ROM therapy, Factor replacement
Do not aspirate
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| What are the most common inherited thombophilias? | Factor V Leiden
Prothrombin mutation (GP20210)
Hyper-homocysteinemia
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| What is the treatment for overdose of thrombolytics? | Aminocaproic acid (Amikar) - inhibits fibrinolysis
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| What are the effects of prostacyclin? | Decreased platelet aggregation, vasodilatation, bronchial relaxation
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| What are the effects of thromboxane? | Increased platelet aggregation, vasoconstriction, bronchial constriction
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| What stimulates B cells to become plasma cells? | IL-4
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| Which complements are anaphylatoxins? | C3a, C5a
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| Which complements make up the membrane attack complex? | C5-9
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| What cells are responsible for immunosurveillance against CA? | Natural killer cells
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| What is the source of histamine in blood? | Basophils
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| What is the source of histamine in tissue? | Mast cells
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| What is endotoxin? Where does it come from? | Lipopolysaccharide A from gram negative bacteria
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| What does an elevated mixed venous oxygen saturation (SvO2) indicate? | >77% - sepsis or cyandide poisoning
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| What does a low mixed venous oxygen saturation (SvO2) indicate? | <66% - decreased CO
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| What are the four intraabdominal abscess locations? | sub-diaphragmatic
sub-hepatic
inter-loop
pelvic
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| What two infections can present within hours post-op? | B-strep
Clostridial (GPR)
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| What is the mechanism of vancomycin? What is the mechanism of it's resistance? | Inhibits cell wall synthesis
Altered cell wall (unable to bind)
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| What is the mechanism of quinolones? | DNA gyrase inhibition
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| What is the mechanism of amphotericin | binds sterols to alter fungal cell wall
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| What antibiotic prolongs neuromuscular blockade? | Clindamycin
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| What are the risks of a blood transfusion? | CMV is highest
Hep C 1:30-150,000
HIV 1:500,000
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| What are the vitamin K dependent factors? | II, VII, IX, X, protein C + S
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| Which antibiotics are bacteriocidal, with irreversible binding to 30S ribosome subunit, and resistance due to decreased active transport? | Aminoglycosides (gentamicin, neomycin, tobramycin)
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| What is the only depolarizing neuromuscular blocker used? | Succinylcholine
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| What is an adverse effect of succinylcholine in burn patients? | hyperkalemia
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| What are the effects of reglan (metoclopramide)? | Dopamine receptor blocker - Increases LES tone and gastric motility
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| What is the mechanism of digoxin? | inhibits Na/K ATPase to increase calcium in heart
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| What is the effect of digoxin? | Slows AV conduction, inotrope but does not increase O2 consumption
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| What pressor is most useful in GIB? | Vasopressin: reduces splanchnic blood floow, portal flow ~40%. Give with B-blocker to avoid angina
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| What gastric contents have the highest concentration of K? | Saliva (20 meq) > gastric (10 meq) > pancreatic/duodenal (5 meq)
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| What is the water distribution in a average person? | 2/3 is intracellular and 1/3 is extracellular (80% of extracellular fluid is interstitial and 20% is plasma)
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| What drug can reverse adverse effects of steroids on wound healing? | Vitamin A
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| How many kcal/g are in protein, fat, and carbs? | Protein: 4 kcal/g
Fat: 9 kcal/g
Carbs: 3.4 kcal/g
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| Describe vitamin D synthesis | Vit D made in skin, to liver for (25-OH, calcidiol), then to kidney for (1-OH, calcitriol), then active
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| What is the respiratory quotient? | Ratio of CO2 produced to O2 consumed
0.7 = fat used
1.0 = carb used
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| What is the preferred fuel of the colon? | Short chain fatty acids - butyric acid
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| Describe fat digestion | Long chain: Micelles to enterocytes to chylomicrons to lymphatics (to jxn LIJ/SCV); medium and short chain are directly absorbed into portal system with aa's and carbs
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| What is the preferred fuel of the small bowel? | Glutamine
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| What is the #1 amino acid in the blood stream? | Glutamine
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| What causes a decrease in glutamine in the blood stream during stress? | Glutamine goes to kidney to form ammonium to help acidosis
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| What vitamin deficiency causes hyperglycemia (relative diabetes) and neuropathy? | Chromium
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| What vitamin deficiency causes perioral rash, hair loss, poor healing, and change in taste? | Zinc
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| What vitamin deficiency causes weakness (respiratory) and encephalopathy? | Phosphate (needed for ATP)
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| What vitamin deficiency causes anemia and neutropenia? | Copper
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| Describe the Cori cycle | glucose to lactate, to the liver, to glucose
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| During starvation, what does the brain use for fuel? | ketones from fatty acids (instead of glutamine)
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| What are the electrolyte concentrations of NS vs LR? | Normal saline: 154 meq Na and Cl
LR: Na 130, K 4, Ca 2.7, Cl 109, bicarb 28
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| What two electrolyte abnormalities cause hyperexcitability (increased reflexes, tetany)? | Hypocalcemia and hypomagnesemia
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| How does magnesium affect calcium? | Low Mg inhibits PTH, so replace MG if difficulty correcting Ca
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| What are the phases of the cell cycle? | G1 - most variable period; S - DNA replication; G2; M - Mitosis
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| What phase of the cell cycle is most sensitive to radiation therapy? | M - mitosis
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| What are the recommendations for biopsy of an extremity sarcoma? | Excisional if < 4cm, otherwise longitudinal incision (less lymphatic disruption, easier to excise scar if biopsy positive)
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| What is a complication of bleomycin and busulfan? | pulmonary fibrosis
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| What are the risks of tamoxifen? | DVT and Endometrial cancer
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| Ret proto-oncogene is diagnostic for what? What is the treatment? | Medullary thyroid cancer
Patient with family history of MEN who has ret proto-oncogene should have total thyroidectomy
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| What is a side effect of vincristine and cisplatin? | Neurotoxicity
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| What cells provide wound contraction? | Myofibroblasts
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| What cells are responsible for healing by secondary intention? | Myofibroblasts
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| What is the principal collagen late in scar? | Type I
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| What is the principal collagen in a healing wound? | III (this is the collagen of granulation tissue)
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| What type of collage is low in Ehler-Danlos? | III
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| What is the time frame of collagen production in a wound? | Begins day 3, max at day 21, then constant amount but more crosslinking, strength
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| What is the order of cells to a healing wound? | Platelets
PMNs
macrophages (essential)
fibroblasts (dominant by day 5)
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| What are the effects of TGF-B? | stimulates fibroblasts and chemotactic for neutrophils (too much/too long can cause fibrosis)
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| What is the effect of PDGF? | Attracts fibroblasts and increases smooth muscle to speed matrix deposition and collagen formation
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| What is the main source of TNF? | Macrophage/monocyte
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| What cell does TNF recruit and activate? | neutrophils
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| How does TNF cause wasting/cachexia in cancer patients? | Anorexia, glycolysis, and lipolysis
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| What is batson's plexus, and what is it's significance? | Valveless vertebral veins that connect to internal vertebral venous plexus
They allow direct mets to the spine
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| What is Poland's syndrome? | Amastia, hypoplastic shoulder, no pectoralis
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| What is Mondor's disease? What is the treatment? | thrombophlebitis of superficial vein of breast. Cord like mass laterally.
Treat with NSAIDS
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| Describe the "T" staging of breast cancer | T1 = <2cm T2 = 2-5cm T3 = >5cm T4 = skin or chest wall involvement
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| Describe the "N" staging of breast cancer | N1 = ipsilateral lymph nodes (1-3 LN on path) N2 = fixed or matted LN (4-9 LN on path) N3 = infraclavicular, supraclavicular, or internal mammary (>10 LN on path)
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| Describe the staging of breast cancer according to TNM guidelines | Stage I = T1 Stage IIA = T1N1 or T2N0; IIB = T2N1, T3N0 Stage IIIA = T1-3 and N2, or T3N1; IIIB = T4N0-2; IIIC = Any T N3
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| How does hormone receptor status in breast cancer affect prognosis? | ER+PR+ > ER-PR+ > ER+PR- > ER-PR-
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| What % of DCIS develop invasive cancer? | 50%
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| What % of LCIS develop invasive cancer? | 30-40% (in either breast)
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| What is the difference pathophysiologically in cancer risk between DCIS and LCIS? | DCIS is a precursor to cancer
LCIS is a marker of risk
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| What % of Phyllodes tumor are malignant? | 10%
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| What is the treatment for Phyllodes tumor? | Wide local excision, rarely mastectomy. No axillary node dissection necessary (spread is hematogenous, not lymphatic)
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| What type of cancer is BRCA1 and BRCA2 associated with? | BRCA1 - ovarian CA (50%)
BRCA2 - male breast CA
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| What are the indication for RT after mastectomy? | >4 nodes
skin or chest wall involvement
+margins
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| What are absolute contraindications to breast-conserving therapy requiring radiation? | Prior radiation to breast/chest wall
Radiation therapy during pregnancy
Diffuse suspicious or malignant appearing microcalcifications
Widespread disease not able to be incorporated by local excision
Positive margins
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| What is the #1 cause of blood nipple discharge? | Intraductal papilloma - no risk of CA
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| What is Stewart-Treves syndrome? | Angiosarcoma arising from chronic lymphadema, often as a complication after mastectomy. Presents as a purplish mass on arm ~10 yrs s/p MRM
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| What is the difference between the two types of alveoli? | Type I: functional gas exchange
Type II: produce surfactant (1% of alveoli)
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| What is the association between the thymus and myasthenia gravis? | 10% of m.g. have thymomas
Resecting thymus (even if no thymoma) in m.g. improves 90%
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| Popcorn lesion on CXR | hamartoma
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| What are the indications for CABG? | intractable symptoms
>50% left main
triple vessel disease
70% LAD + 1 other vessel
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| What is the treatment for a patent ductus arteriosus | Indomethacin - blocks PG production - effective in ~70%
Surgery for those that don't close at 6 months of age
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| What are the effects of IABP? | Augments diastolic coronary blood flow and reduces afterload by inflating during diastole (inflates 40msec before T wave, deflates with p wave)
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| What electrolytes are actively secreted by the colon? | K and HCO3
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| Describe the blood supply of the rectum | Superior rectal artery off IMA
Middle off internal iliac
Inferior off internal pudendal (off internal iliac)
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| What are the most common genetic mutations in colon cancer? | p53 (85%), DCC (70%), ras (50%)
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| Amsterdam criteria | 3 1st generation relatives, over 2 generations, 1 diagnosed before age 50
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| Gardner's syndrome | colon CA and desmoid tumors
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| Turcot's syndrome | colon CA and brain tumors
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| Peutz Jeghers | polyposis and mucocutaneous pigmentation; increased risk of GI, gonadal, breast cancers
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| What gene is associated with sacroiliitis in IBD? | HLA B27
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| Where are most anal fissures located? | posterior midline, 10% are anterior in women
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| What are the causes of anal fissures which are lateral or recurrent? | IBD, TB, or syphilis
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| What is normal LES tone and length? | 15-25 mm Hg, 4cm long, 40cm from incisors
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| What is the treatment of diffuse esophageal spasm? | calcium channel blockers
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| What is the pathophysiology of achalasia? | Decreased ganglion cells in Auerbach's plexus, absence of peristalsis and esophageal dilation. High LES pressures
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| What is main arterial supply to stomach when used to replace esophagus? | right gastroepiploic artery
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| What is the treatment of esophageal leiomyoma? | If symptomatic or >5cm excise by enucleation via thoracotomy (R if middle, L if lower esophagus)
Do not biopsy on EGD
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| What is Killian's triangle? | A potentially weak spot where a pharyngoesophageal diverticulum (Zenker's) is more likely to occur. Posterior triangular area in the pharynx between the inferior constrictor and the cricopharyngeus muscle
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| What is a painless mass on the roof of the mouth? | Torus - bony exotosis, midline of palate
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| Which has a greater risk for cancer, leukoplakia or erythroplakia? | Erythroplakia
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| What is the general treatment for different stages of head and neck SCCa? | Stage I+II(up to 4cm, no nodes) Rx with single modality (surgery or RT)
Stage III+IV get combined modality
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| What is the treatment for glottic Ca? | If cords not fixed, then RT
If cords fixed, need surgery and RT
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| What is the most common type of lip cancer? | Epidermoid carcinoma. Lower > upper due to sun exposure
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| What is the usually presentation of nasopharyngeal carcinoma? | 50% presesnt late (as neck mass). Drain to posterior neck nodes. A/w EBV
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| What is the treatment of lip cancer? | Resect, primary closure if <1/2 of lip, otherwise flaps. Radical neck dissection if node+
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| What is Plummer-Vinson syndrome? What type of cancer is increased? | Triad of dysphagia (due to esophageal webs), glossitis, and iron deficiency anemia. Increased risk of esophageal/tongue Ca
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| What are the most common malignant salivary gland tumors? | #1 - Mucoepidermoid carcinoma #2 - Adenoid cystic carcinoma (#1 of submandibular and minor glands)
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| What are the most common benign salivary gland tumors? | Pleomorphic adenoma (#1 overall), Warthin tumor
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| What is the treatment for a benign salivary gland tumor? | Superficial parotidectomy (spare CNVII). If malignant, take whole parotid. If high grade, need radical neck dissection
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| What is the difference between a radical neck dissection and a modified radical neck dissection? | Radical neck takes CN XI, SCM, IJ. Modified spares some combination of those structures (CN XI is most morbid)
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| What is the cause of unilateral nasal obstruction and recurrent epistaxis in a teen male? What is the treatment? | Juvenile Nasopharyngeal Angiofibroma - benign but locally agressive vascular tumor of nasal cavity. Embolize (internal maxillary artery), then extirpate
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| What is a replaced right or left hepatic artery? | Replaced right - originating off SMA (occurs in 17%) Replaced left - originating off left gastric (occurs in 10%)
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| What are Kupffer cells? | Specialized macrophages in the liver responsible for clearing portal blood and immunosurveillance. Also responsible for early alcohol-induced liver injury.
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| Describe the anatomical relationship of the Portal triad | Portal vein posterior to CBD (on R) and hepatic artery (on L)
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| What is the #1 cause of benign biliary stricture? | Iatrogenic (lap chole)
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| What are the symptoms and treatment of cholangitis? | Fever, RUQ pain, jaundice, +/- hypotension, MS changes. Needs immediate IV Abx, IVF, emergent decompressions/drainage of CBD
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| What is the treatment of gallbladder adenocarcinoma? | Cholecystectomy adequate if confined to mucosa. If grossly visible tumor - regional lymphadenectomy, wedge segment V, skeletonize portal triad
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| What is the triad of hemobilia? | UGIB, RUQ pain, and jaundice - caused by fistula between biliary duct and hepatic arterial system
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| What is the treatment of hemobilia? | workup and treatment with arteriogram
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| How does the gallbladder concentrate bile? | Active absorption of Na, Cl (H20 then follows)
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| What is the treatment for hepatic adenoma? | Hepatic adenoma is an indication for resection 10% rupture/bleed + malignant potential
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| What is the treatment for hepatic hemangioma? | Do nothing unless giant or symptomatic/consumptive
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| What is Kasabach-Merritt syndrome? | Consumptive coagulopathy or CHF due to hemangioma - usually in infants.
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| What is the treatment of liver amebic abscess? | metronidazole, not surgical
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| What is the treatment of hydatid cysts? | Surgical resection with chemotherapy before and after (albendazole or mebendazole)
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| What is the work-up of hydatid cysts? | Casoni skin test + Indirect hemagglutination
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| What are the main risk factors for hepatocellular carcinoma? | Alcoholism, Hep B+C, hemochromatosis, PBC, aflatoxin, alpha-1-antitrypsin deficiency - PBC and Wilson's are not risk factors
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| What type of HCC has best prognosis? | Fibrolamellar
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| What is the difference between these types of peripheral nerve injuries: neuropraxis, axonotmesis, neurotmesis? | Neuropraxis - focal demyelination, improves Axonotmesis - loss of axon continuity (nerve and sheath intact). Regen 1mm/day Neurotmesis - loss of nerve continuity, surgery required for nerve recovery
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| What triggers ADH release? | Produced when high osmolarity is sensed at supraoptic nucleus of hypothalamus
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| What is Diabetes Insipidus? | Alcohol and head injury inhibit ADH release - high UOP, low urine SG, high serum osmolarity/Na
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| What is SIADH? | Increased ADH release most often by head trauma/tumors or SCLC. Oliguria, high urine osmolarity, low serum osmolarity/Na
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| What is the effect of ADH? | Causes increased free water absorption at the distal tubules and collecting ducts and increases peripheral vascular resistance
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| What is cerebral perfusion pressure? | Mean Arterial Pressure (MAP) - Intracranial Pressure (ICP)
Keep ~70
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| What is Cushing's triad? | Hypertension, bradycardia, and Kussmaul respirations (slow, irregular) associated with increased ICP
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| Describe the Glasgow Coma Scale ratings | Motor: 6 commands, 5 localizes, 4 withdraw pain, 3 flexion, 2 extension, 1 none
Verbal: 5 oriented, 4 confused, 3 inappropriate, 2 incomprehensible, 1 none
Eyes: 4 spont, 3 command, 2 pain, 1 none
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| What are the signs of spinal shock? | Hypotension with bradycardia, warm perfused extremities (vasodilation)
Cord injury above T5
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| What are the deficits in anterior spinal artery syndrome? | Lose bilateral motor, pain, and temperature.
Keep position sense, light touch
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| What is Brown-Sequard syndrome? | Spinal cord hemi-transection
Lose ipsilateral motor, contralateral pain and temperature
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| What is Central Cord Syndrome? | Acute cervical spinal cord injury characterized by bilateral loss of upper extremity motor, pain, and temperature; legs relatively spared. Often due to hyperextension
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| What are the indications to operate on a skull fracture? | If open or depressed
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| What are the effects of L3-L4 disc herniation? | L4 root compresson - quadriceps, week knee jerk
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| What are the effects of L4-L5 disc herniation? | L5 root compression - foot drop, possible big toe hyperesthesia
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| What are the effects of L5-S1 disc herniation? | S1 root compression - weakness in plantar flexion (pushing off toes), weak ankle jerk, hyperesthesia lateral foot/calf
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| What is the terrible triad of O'Donaghue? | lateral blow to knee - injury to ACL, MCL, medial meniscus
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| What does the medial nerve do? | thumb apposition, sensation to most of palm, 1st 2 1/2 fingers (carpal tunnel)
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| What does the ulnar nerve do? | intrinsic musculature of hand, finger abduction, wrist flexion, sensation to 2 1/2 fingers/back of hand
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| What does the radial nerve do? | Wrist/finger extension, sensation to back of lateral hand; no motor in hand
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| What are the benefits of early ORIF in femur fracture? | early mobilization
decreased fat embolization
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| What is a Salter-Harris fracture? Which types need open procedures? | fracture that involves the epiphyseal plate or growth plate of a bone
Types III, IV, V are intra-articular and thus need open repair
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|
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| What are the signs of hip dislocation? | Posterior (90%) - internal rotation, flexed, abducted thigh
Anterior - frog leg (external rotation, abduction)
🗑
|
||||
| What three fractures are prone to compartment syndrome? | Calcaneous, tibia, supracondyle of humerus
🗑
|
||||
| What is treatment of knee dislocation? | Most texts say arteriogram all posterior, but at least some vascular assessment (ABI/CT angio/duplex US) is necessary to evaluate popliteal injury even in the presence of normal vascular assessment
🗑
|
||||
| What nerve is commonly injured in shoulder dislocation? | axillary nerve in anterior dislocation (90% of dislocations)
🗑
|
||||
| What is a Volkmann's contracture? What is the treatment? | Permanent flexion contracture of the hand at the wrist.
Caused by supracondylar humerus fx -> compromised anterior interosseous artery -> deep forearm flexor compartment syndrome
Needs fasciotomy
🗑
|
||||
| What does a tender snuffbox indicate? | Navicular fracture - even with negative XR, requires cast up to elbow
🗑
|
||||
| What is a Dupuytren's contracture? What is the treatment? | Progressive proliferative of palmar fascia causing flexion contracture of fingers of hand, unknown exact cause (trauma, DM, EtOH, epilepsy)
Treatment with steroids, physical therapy, but may need fasciotomy
🗑
|
||||
| What is a Monteggia fracture? What is the treatment? | proximal ulnar fracture with radial head dislocation
Treat with ORIF
🗑
|
||||
| What is a sunburst pattern on x-ray suggest? | Osteogenic sarcoma
🗑
|
||||
| What does "onion layering" on x-ray suggest? | Ewing sarcoma
🗑
|
||||
| What do pseudorosettes on path suggest? | Ewing sarcoma
🗑
|
||||
| What are the signs of annular pancreas? Treatment? | Double bubble on x-ray. Prone to pancreatitis, possible obstruction.
Treat obstruction with duodenojejunostomy, do not resect pancreas
🗑
|
||||
| What is effective pain relief for non-resectable pancreatic CA? | Celiac plexus block (50% EtOH on both sides of aorta near celiac)
🗑
|
||||
| What is treatment of pancreatic pseudocyst? | Expectant management initally - 85% resolve on their own
If persistent and symptomatic - internal drainage by cyst-gastrostomy, -duodenostomy, or -jejunostomy
🗑
|
||||
| What are the signs of an insulinoma? Treatment? | Whipple's triad (symptoms of hypoglycemia, glucose <45, improvement with glucose)
Insulin to glucose ratio >0.4
Increased C-peptide
Rx = enucleation (though 90% are benign)
🗑
|
||||
| What are the boundaries of the gastrinoma triangle? | (1) cystic/CBD junction
(2) 3rd part of the duodenum
(3) neck of the pancreas
🗑
|
||||
| What are the signs of gastrinoma? | Severe ulcer disease, diarrhea (lipase destruction by acid, malabsorption, incr secretion)
🗑
|
||||
| What test evaluates gastrinoma? | Secretin stimulation test - normal patients will decrease gastrin
Though a serum gastrin level >1000 is virtually diagnostic
🗑
|
||||
| What are the symptoms of a somatostatinoma? | gallstones
steatorrhea
pancreatitis
diabetes
🗑
|
||||
| What are the symptoms of a glucagonoma? Treatment? | diabetes
glossitis
stomatitis
necrolytic migratory erythema (presenting problem in 70%)
Rx = streptozocin/doxorubican (selectively destroy alpha cells) and octreotide (inhibits release)
🗑
|
||||
| What are the symptoms of VIP-oma? | WDHA syndrome = watery diarrhea hypokalemia achlorydia
🗑
|
||||
| What is the treatment for a choledochal cyst? | Must excise, leaving cyst increases cancer, pancreatitis, and cholangitis risks
Transplant if type IV or V
🗑
|
||||
| What are the types of choledochal cysts? | I - (>90% of cysts) dilatation of CBD (part or whole)
II - diverticulum
III - choledochocele involving sphincter
IV - intra and extrahepatic cysts (Caroli's disease)
V - intrahepatic cysts
🗑
|
||||
| What is pulmonary sequestration? Treatment? | mass of non-functioning primitive tissue in the lung
Extralobar - systemic artery and vein - resection not necessary
Intralobar (75%) - aorta in and pulmonary vein out - lobectomy for recurrent infections
🗑
|
||||
| What is the #1 presentation of pulmonary sequestration? | infection
🗑
|
||||
| What is the cause of respiratory distress at birth, and massive hyperinflation of a single lobe of the lung? What is the treatment? | Congenital lobar emphysema
Rx: lobectomy, excellent prognosis
🗑
|
||||
| What is the first sign of CHF in children? | hepatomegaly
🗑
|
||||
| What is the treatment for a strawberry hemangioma | observation - most involute by age 7
🗑
|
||||
| What is the #1 pediatric malignancy overall? | leukemia
🗑
|
||||
| What gene is neuroblastoma associated with? | N-myc
🗑
|
||||
| What is elevated in neuroblastoma? | VMA - Vanillyl mandelic acid
HVA - homovanillic acid
🗑
|
||||
| What is the treatment for biliary atresia? | Kasi procedure - hepatoportoenterostomy - before age 3 months
🗑
|
||||
| What is the #1 cause of painless GIB in children? | Meckel's diverticulum
🗑
|
||||
| What is the embryologic origin of a Meckel's diverticulum? | Persistent omphalomesenteric duct
🗑
|
||||
| What is the treatment of intussusception in children? | air/contrast enema (max 120mm Hg)
IV glucagon can help (relaxes smooth muscle)
OR if free air/peritonitis
🗑
|
||||
| What is the cause of intestinal atresia? | Intra-uterine vascular events
Mother may have polyhydramnios
🗑
|
||||
| What is the surgical treatment for malrotation? | Ladd's procedure - appendectomy, take down bands, counterclockwise rotation
🗑
|
||||
| What is a cystic hygroma? What is the most common location? | lymphangioma - left posterior triangle of neck
🗑
|
||||
| What is the treatment for a thyroglossal duct cyst? | Sistrunk procedure - en bloc excision of cyst (midline) with hyoid bone (there is a risk of malignant degeneration of thyroid tissue in cyst)
🗑
|
||||
| What is the #1 complication of cystic hygroma? | infection
🗑
|
||||
| What is the treatment for a Wilm's tumor? | nephrectomy (80% cure)
🗑
|
||||
| What is the most common type of tracheo-esophageal fistula? | Type C - blind esophagus, distal TE fistula. Spit up feeds, NGT won't pass
🗑
|
||||
| What other abnormalities can a patient with a tracheoesophageal fistula have? | VACTERL - vertebral, anal atresia, cardiovascular, TEF, esophageal atresia, renal, limb defects - structures derived from embryonic mesoderm
🗑
|
||||
| What is the #1 cause of a colon obstruction in a newborn? | Hirschsprung disease - no BM in first 24 hrs, diagnose with rectal bx
🗑
|
||||
| What is the treatment for a meconium ileus? | Gastrograffin enema - diagnostic and therapeutic
🗑
|
||||
| How does necrotizing enterocolitis in a newborn present? | After initiating feeds in a neonate (premie) in the 2nd or 3rd week of life with blood in the stool OR free air/peritonitis/acidosis Classic triad: abd dist, bloody stools, pneumatosis
🗑
|
||||
| What is the treatment for imperforate anus? | If low - anoplasty If high (meconium in urine, fistula to bladder, vagina, or urethra) - need colostomy
🗑
|
||||
| What are the characteristics of gastroschisis? | Congenital abd wall defect, intrauterine rupture of umbilical cord, no associated defects, lateral (right) defect, no sac
🗑
|
||||
| What are the characteristics of omphalocele? | midline defect, may contain liver or other non-bowel contents, frequent anomalies, has peritoneal sac.
🗑
|
||||
| What converts norepinephrine to epinephrine? | PNMT - Phenylethanolamine N-methyltransferase
🗑
|
||||
| What are the common characteristics of a pheochromocytoma? | 10% are: malignant, bilateral, in children, part of MEN, extra-adrenal
🗑
|
||||
| What is the most common extra-adrenal location for a pheochromocytoma? | Organ of Zuckerkandl at aortic bifurcation
🗑
|
||||
| What is the pre-operative management for a pheochromocytoma? | alpha-blockers first, then beta-blockers if tachycardic
🗑
|
||||
| How is the diagnosis of pheochromocytoma made? | screen with urine metanephrines, VMA; MIBG can localize
🗑
|
||||
| What is Nelson's syndrome? | rapid enlargement of a pituitary adenoma that occurs after bilateral adrenalectomy (10%) - incr ACTH, muscle weakness, pigmentation, vision changes
🗑
|
||||
| What is Waterhouse Friderichsen syndrome? | adrenal hemorrhage a/w meningococcal sepsis
🗑
|
||||
| What is Conn's syndrome? | hyperaldosteronism = 80% adenoma, 20% bilateral hyperplasia - HTN, low K, high Na
🗑
|
||||
| What is Addison's disease? | low aldosterone and glucocorticoids = low Na, high K, hypoglycemia. Crisis presents similar to sepsis with hypoTN, fever; steroids are diagnostic and therapeutic
🗑
|
||||
| What is the most common cause of congenital adrenal hyperplasia? | 21-hydroxylase deficiency
🗑
|
||||
| What is Cushing's disease? | Excessive secretion of ACTH from the anterior pituitary, usually from a pituitary adenoma. Causes 70% of non-iatrogenic Cushing's syndrome.
🗑
|
||||
| What is the most common cause of Cushing syndrome? | iatrogenic
🗑
|
||||
| What is Cushing's syndrome? | hormone disorder with high levels of cortisol - symptoms include characteristic weight gain (truncal obesity, moon face, buffalo hump), purple striae, hirsutism, polyuria, htn, insulin intolerance
🗑
|
||||
| How do you determine the type of Cushing syndrome? | Dexamethasone suppresion test: Pituitary - high ACTH, cortisol suppressed with steroids Adrenal - low ACTH, not suppressed Ectopic - high ACTH, not suppressed
🗑
|
||||
| What hormones does the anterior pituitary secrete? | GH, ACTH, TSH, LH, FSH, Prolactin
🗑
|
||||
| What hormones does the posterior pituitary secrete? | ADH, Oxytocin
🗑
|
||||
| What is the classic vision change with pituitary mass effect? | Bitemporal hemianopsia - vision missing in outer half of both right and left visual fields
🗑
|
||||
| What is the #1 pituitary adenoma? What are the symptoms? | Prolactinoma - galactorrhea, irregular menses
🗑
|
||||
| What is Sheehan syndrome? | postpartum lack of lactation and persistent amenorrhea caused by necrosis of pituitary from blood loss during/after childbirth
🗑
|
||||
| What is the treatment for a prolactinoma? | Bromocriptine or transphenoidal resection
🗑
|
||||
| What is the pathophysiology of hidradenitis? | involves apocrine glands, thus seen after puberty
🗑
|
||||
| What are the three steps to the healing of a skin graft? | Imbibition, inosculation, revascularization
🗑
|
||||
| What is the most common cause of flap necrosis? | venous thrombosis
🗑
|
||||
| What type of cancer demonstrates "peripheral palisading" of nuclei and "retraction artifact" | Basal cell carcinoma
🗑
|
||||
| What are the common sites for melanoma? | Skin > eyes > rectum
#1 skin site for men = back, women = legs
Worse prognosis on "BANS" - back arms, neck, scalp
🗑
|
||||
| What type of scar extends beyond margins: keloid or hypertrophic? | keloid
🗑
|
||||
| What is the cause of keloid scar? | failure of collagen breakdown and increased collagen production
🗑
|
||||
| What are the four major types of melanoma? | superficial spreading (most common), nodular, lentigo maligna, acral lentiginous
🗑
|
||||
| What is the Breslow classification of melanoma? | <0.75 mm (90% cure)
0.75-1.5mm
1.5-4mm
>4mm (80% distant mets)
🗑
|
||||
| What type of melanoma has the best prognosis? worst prognosis? | best = lentigo maligna; worst = nodular
🗑
|
||||
| What are the surgical margins for resection of a melanoma? | in situ = 0.5-1 cm margin
<1mm depth = 1 cm margin
1-2mm depth = 1-2 cm margin (with SNL)
>2mm depth = 2 cm margin
🗑
|
||||
| What is MALT a precursor to? | gastric lymphoma - regresses with H. pylori treatment
🗑
|
||||
| What are the types of gastric ulcers? | Type I - lesser curve/body Type II - 2 ulcers (lesser curve and duodenum) Type III - prepyloric (w/i 3 cm) Type IV - high lesser curve/proximal Type V - anywhere a/w NSAIDS
🗑
|
||||
| What is the association between gastric ulcers and blood type? | Type I = blood type A; Others = type O
🗑
|
||||
| What margins are necessary for gastric cancer resection? | 5-6cm due to intramural microscopic spread and extensive lymphatics around stomach
🗑
|
||||
| What are the effects of a terminal ileum resection? | Decreased bile salt absorption -> less colonic H20 absorption -> diarrhea; Decreased B12/intrinsic factor absorption; Decreased binding of oxalate -> oxalate absorbed in colon -> more oxalate stones
🗑
|
||||
| What are the symptoms of carcinoid syndrome? | flushing, diarrhea, asthma, R sided heart valve dz
🗑
|
||||
| What is the test for carcinoid syndrome? | urinalysis for 5-HTP (secreted by foregut), 5-HIAA, and serotonin
🗑
|
||||
| What factors prevent a fistula from healing? | FRIENDS - foreign body, radiation, IBD, epithelization, neoplasm, distal obstruction, sepsis/infection
🗑
|
||||
| What chemotherapy agents are used for carcinoid tumors? | Steptozocin, doxorubicin, 5 FU
🗑
|
||||
| What is the surgical treatment for a crohn's patient with multiple strictures? | Do not do resection (to avoid short gut) do stricturoplasties
🗑
|
||||
| What % of patients with carcinoid tumors get carcinoid syndrome? | 9% - mostly those with extensive mets to the liver
🗑
|
||||
| What cells produce calcitonin? | parafollicular C cells - derived from neural crest cells
🗑
|
||||
| What is the effect of propylthiouracil (PTU)? | Peripherally and centrally blocks conversion of T4 to T3
🗑
|
||||
| What are side effects of PTU? | crosses placenta - cretinism, agranulocytosis, and liver damage
🗑
|
||||
| What drugs peripherally block conversion of T4 to T3? | PTU, Propanolol, Prednisone (& other steroids) and methimazole
🗑
|
||||
| What is the Wolk Chaikoff effect? | Reduction in thyroid hormone levels after a large ingestion of iodine - useful in thyroid storm
🗑
|
||||
| What is the main limitation of FNA in a solitary thyroid nodule? | Differentiation of benign vs malignant follicular and Hurthle cell neoplasms
🗑
|
||||
| What do Psammoma bodies bodies on the pathology of an FNA of a thyroid suggest? | Papillary thyroid cancer
🗑
|
||||
| What is the most common type of thyroid cancer? | Papillary
🗑
|
||||
| What % of papillary cancer present with positive nodes? | 20% of adults, 80% of children
🗑
|
||||
| What is the population distribution of papillary thyroid cancer? | F:M ratio is 3:1
1/2 are before age 40
🗑
|
||||
| What does amyloid on FNA of a thyroid suggest? | Medullary thyroid cancer
🗑
|
||||
| What gene is associated with medullary thyroid cancer? | ret proto-oncogene
🗑
|
||||
| What % of patients with medullary thyroid cancer have MEN2? | 20% (tend to be bilateral, younger, worse prognosis)
🗑
|
||||
| What is the first step in work-up of thyroid nodule after H&P? | FNA
🗑
|
||||
| What are the limitations of treatment of thyroid cancer during pregnancy? | No radioactive iodine during pregnancy or breast-feeding; Operate in second trimester if possible
🗑
|
||||
| What does the superior laryngeal nerve innervate? | motor to cricothyroid muscle (projection and high pitch), sensory to supraglottis
🗑
|
||||
| What does the recurrent laryngeal nerve innervate? | All muscle of larynx except cricothyroid
🗑
|
||||
| What is the embryologic origin of the parathyroids? | Superior from 4th pharngeal pouch, inferior from 3rd; both receive blood supply from inferior thyroid artery
🗑
|
||||
| What electrolyte abnormalities are present in primary hyperparathyroidism? | Elevated calcium, low phosphate
🗑
|
||||
| What disease is associated with osteitis fibrosa cystica? | hyperparathyroidism
🗑
|
||||
| What % of patients with hyperparathyroidism have a single gland adenoma? | 85%
🗑
|
||||
| What is MEN I? | Wermer's syndrome - parathyroid, pancreas, pituitary (prolactinoma most common)
🗑
|
||||
| What is MEN IIa? | Sipple syndrome - Parathyroid, adrenal (pheochromocytoma), and thyroid
🗑
|
||||
| What is MEN IIb? | Thyroid, adrenal, mucosal neuromas/marfan
🗑
|
||||
| What type of cell mediates graft vs host disease? | T cells
🗑
|
||||
| What causes hyperacute rejection? | pre-formed antibodies
🗑
|
||||
| What test can identify patients who will develop hyperacute rejection? | Crossmatch
🗑
|
||||
| What causes acute rejection? | Foreign MHC antigens of graft cells
🗑
|
||||
| During what timeframe is acute rejection at highest risk to occur? | 1 week to 3 months
🗑
|
||||
| What is the mechanism of chronic rejection? | Fibrosis of blood vessels of transplanted tissue - loss of blood supply
🗑
|
||||
| What is the mechanism of acute rejection? | Due to HLA mismatch, lymphocytic activation by foreign MHC antigens of graft cells
🗑
|
||||
| Which risk is higher in patients on immunosupression: viral or bacterial infection? | Viral > bacterial because immunosuppression is largely cellular and not humoral
🗑
|
||||
| What is the #1 viral infection post transplant? | CMV
🗑
|
||||
| What is the mechanism of azathioprine (Imuran)? | 6MP derivative, purine analog that acts as an antimetabolite, decreases DNA synthesis
🗑
|
||||
| What is the mechanism of cyclosporine? | Calcineurin inhibitor - inhibits mRNA encoding of IL-2
🗑
|
||||
| What is the mechanism of mycophenolate (cellcept)? | blocks purine synthesis to decrease T and B cell proliferation
🗑
|
||||
| What is the mechanism of tacrolimus (FK506)? | Calcineurin inhibitor - blocks IL-2 expressions/production from T cells - more potent than cyclosporine
🗑
|
||||
| What is the mechanism of immunosuppression of prednisone? | blocks IL-1 from macrophages
🗑
|
||||
| What is the mechanism of sirolimus (Rapamune)? | mTOR inhibitor - inhibits the response of IL-2 thereby blocking the activation of T and B cells
🗑
|
||||
| What is the most common cause of biliary complications post liver transplant? | ischemia - check hepatic arterial flow
🗑
|
||||
| What is the #1 cause of oliguria s/p renal transplant? | ATN
🗑
|
||||
| What are the zones of the neck? | I - cricoid to sternum (thoracic inlet)
II - angle of mandible to cricoid
III - base of skull to angle of mandible
🗑
|
||||
| What is a positive DPL? | gross blood, or identification of food particles, bacteria, bile, >100K RBC/mm, or 500 WBC/mm
🗑
|
||||
| What are the indications for thoracotomy after chest tube placement? | >1500 cc blood out initially or >200 cc/hr x3 hours
🗑
|
||||
| What is the cause of petechiae, hypoxia, and confusion/agitation after a femur fracture? How is the diagnosis made? | Fat emboli;
Sudan urine stain for fat
🗑
|
||||
| What are traumatic diaphragm injuries usually located? | 8:1 on the left
🗑
|
||||
| What are the effects of splenectomy on the immune system? | decreased tuftsin, properidin, and fibronectin (non-specific opsonins), decreased IgM production - susceptible to encapsulated organisms
🗑
|
||||
| What % of patients does splenectomy improve: hereditary spherocytosis? ITP? | 100% spherocytosis
80% ITP
🗑
|
||||
| What is the treatment for TTP? | plasmapheresis, not splenectomy
🗑
|
||||
| What are the physiological effects of ARDS? | decreased pulmonary compliance
🗑
|
||||
| How does aging affect PFTs? | reduces FEV1 and FRC
🗑
|
||||
| What equation describes oxygen delivery? | CO x O2 content = CO x Hgb x 1.3 x SpO2
🗑
|
||||
| What equation describes oxygen use? | CO x (CaO2 - CvO2)
🗑
|
||||
| What are the effects of PEEP on the lungs? | Increased FRC, increased compliance
🗑
|
||||
| What is functional residual capacity (FRC)? | air in lungs after normal exhalation
🗑
|
||||
| What is inspiratory capacity? | maximum amount of air able to be inhaled (TV + inspiratory reserve volume IRV)
🗑
|
||||
| What is vital capacity? | greatest volume that can be exhaled (IRV + TV + ERV)
🗑
|
||||
| What causes an increase in oxygen dissociation from hemoglobin ("right shift")? | increased temperature, CO2, H+, 2,3DPG (high altitude, babies)
🗑
|
||||
| What is the treatment of carbon monoxide poisoning? | 100% O2 - reduces CO half-life from 5 hrs to 1 hr
🗑
|
||||
| What are the characteristics of silvadene? | good activity against candida/pseudomonas, poor eschar penetration. risk of neutropenia
🗑
|
||||
| What are the characteristics of mafenide acetate (sulfamylon)? | painful, can cause acidosis due to carbonic anhydrase inhibition
🗑
|
||||
| What are the characteristics of silver nitrate? | Can cause hyponatremia and hypochloremia due to leeching of NaCl
🗑
|
||||
| What is the #1 infection in burn patients? | pneumonia
🗑
|
||||
| What is a Marjolin's ulcer? | SCCA that develops in a chronic burn wound
🗑
|
||||
| What is the effect of EDRF (endothelium derived relaxing factor) | vasodilation via cGMP, increased in sepsis; nitric oxide is most common example
🗑
|
||||
| What are markers for non-seminomatous testicular cancer? | AFP and B-HCG
🗑
|
||||
| What is the surgical approach to biopsy a testicular mass? | Orchiectomy via inguinal incision. Never trans-scrotal
🗑
|
||||
| What stage seminomas get RT? Chemotherapy? | All stages - very radiosensitive
Node + get platinum-based chemo
🗑
|
||||
| What are the long term effects of cryptorchidism? | increased testicular cancer, orchiopexy can increase fertility but not decrease cancer risk
🗑
|
||||
| What is the treatment of testicular torsion? | Bilateral orchiopexy
🗑
|
||||
| How is a urethral injury diagnosed? | retrograde urethrogram (RUG), do not place foley - needs suprapubic catheter
🗑
|
||||
| What is the treatment for a traumatic bladder injury? | Extraperitonal - a/w pelvic fx, foley only for drainage
Intraperitoneal - no pelvic fx, usually dome rupture - laparotomy with multi-layer closure and foley
🗑
|
||||
| What are the most common type of kidney stones? | oxalate - especially after small bowel resection
🗑
|
||||
| What type of kidney stones are associated with proteus infection? | struvite stones, "staghorn" - proteus produces urease
🗑
|
||||
| What is the classic triad of renal cell carcinoma? | abd pain (capsule stretching), mass, hematuria
🗑
|
||||
| Where is erythropoetin made? What stimulates its production? | 95% made in kidney, stimulated by hypoxia, (decreased production in ESRD)
🗑
|
||||
| What causes fever and hypertension in a renal cell carcinoma patient? | Increased erythropoetin - erythrocytosis
🗑
|
||||
| What is the #1 peripheral aneurysm? | popliteal
🗑
|
||||
| What are popliteal aneurysms associated with? | 50% bilateral, 1/3 have AAA
🗑
|
||||
| When do you treat a splenic aneurysm? | If >2 cm, child bearing age, planning pregnancy, or symptomatic then resect, otherwise can just monitor
🗑
|
||||
| Bloody diarrhea POD#2 after AAA repair - what is the next step? | sigmoidoscopy to eval for ischemia (due to loss of IMA) - if necrosis then take to OR
🗑
|
||||
| What is the initial treatment of claudication? | smoking cessation, excercise, trental - not surgery
🗑
|
||||
| What is the #1 CN injury during CEA? | vagus nerve (clamp application) - hoarseness
🗑
|
||||
| What are the long-term effects of PID? | Increased risk of infertility and ectopic pregnancy
🗑
|
||||
| What is a Krukenberg tumor? | colon or stomach CA met to ovary - see signet cells on path
🗑
|
||||
| What is Meig's syndrome? | pelvic tumor -> ascites, hydrothorax
🗑
|
||||
| Rectal bleeding, irregular menses, pelvic pain, and bluish mass on proctoscopy in a female - what is the diagnosis? | Endometriosis involving the rectum
🗑
|
||||
| What is the treatment of endometriosis? | hormonal therapy
🗑
|
||||
| What is the staging of ovarian cancer? | I - limited to ovary
II - in pelvis
III - throughout abdomen
IV - distant mets
🗑
|
||||
| What is a Howship Romberg sign? | inner thigh pain with internal rotation - indicates obturator hernia
🗑
|
||||
| What does the ileoinguinal nerve innervate? | sensation to inner thigh and scotum
🗑
|
||||
| What does the genitofemoral nerve innervate? | travels along spermatic cord to innervate cremaster muscle and scrotal skin
🗑
|
||||
| What is a spigelian hernia? | Hernia inferior to linea semicircularis through linea semilunaris - deep to ext oblique
🗑
|
||||
| What is a Petit's hernia? | Hernia through lumbar triangle (iliac crest, ext oblique, latissimus dorsi)
🗑
|
||||
| Describe the innervation to the pectoralis muscles | Medial pectoral nerve to pec major and minor; lateral pectoral nerve to pec major only
🗑
|
||||
| What biopsy finding in fibrocystic disease of the breast has an increased cancer risk? | Atypical ductal or lobular hyperplasia
🗑
|
||||
| What is the FEV1 required for a: wedge resection? lobectomy? pneumonectomy? | 0.6L; 1L; 2L
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| What ABG values increase the risk of a lung resection? | pCO2 >45 or pO2 <50 at rest
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| What marks the transition between the anal canal and the rectum? | Levator ani
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| What is primary, secondary, and tertiary peristalsis? | Primary - CNS initiates swallow, occurs with food bolus; Secondary - occurs with esophageal distention (propagating waves); Tertiary - non-propagating/dysfunctional
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| What is the most common site of esophageal perforation? | Cricopharyngeal muscle (usually by EGD)
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| What is Mirizzi syndrome? | Compression and/or inflammation of common hepatic duct by a stone in the infundibulum of the gallbladder causing stricture and hepatic duct obstruction
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| What is the normal half-life of: RBCs? PMNs? platelets? | RBC - 120 days; PMNs - 1-2 days; platelets - 7 days
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| What is the mechanism and effect of Amrinone? | Phosphodiesterase inhibitor - inotrope, increases CO and decreases SVR
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| What is a side effect of carbapenems? | Seizures
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| What are side effects of aminoglycosides? | Reversible nephrotoxicity, irreversible ototoxicity
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| What is the mechanism of rifampin? | RNA polymerase inhibitor
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| Which antibiotic can affect platelets? | PCNs and cephalosporins - can bind platelets and increase bleeding times
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| What triggers renin release? | Macula densa senses low Na/Cl
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| What is the mechanism of malignant hyperthermia? | Ca release from sarcoplasmic reticulum
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| What does antithrombin III do? | binds to and inhibits thrombin; inhibits factors IX, X, XI. Heparin binds this
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| How do you calculate nitrogen balance? | N balance = N in - N out = Protein/6.25 - (24 hr urine N + 4g)
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| What converts natural killer cells to lymphokine activated killer cells? | IL-2
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| What is the mechanism of metronidazole? | produces oxygen radicals that breakup DNA
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| What are the effects of ketamine? | increases cardiac work, O2 use, secretions, and BP; no respiratory distress; hallucinations possible
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| What are side effects of vancomycin? | Redman syndrome (histamine release), nephrotoxicity, ototoxicity
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| What are side effects of metronidazole? | Disulfiram-like reaction, peripheral neuropathy
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| What are 3 laboratory indications of low volume, "pre-renal" | FeNa <1, Urine Na <20, BUN/Cr >30
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| What is the function of peptide YY? Where is it secreted? | inhibits acid secretion, "ileal break"; released from terminal ileum
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| How does prostate surgery affect clotting? | Can release urokinase -> activates plasminogen -> thrombolysis
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| How do sequential compression devices work? | Improve venous return and release tPA -> induce fibronolysis
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| What are the side effects of halothane? | renal and liver toxicity
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| What fractures are associated with non-union? | clavicle, 5th metatarsal fracture
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| Which organisms are carbapenems least effective against? | MEPP: MRSA, enterococcus, proteus, pseudomonas
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| What are indications for radiation to an extremity sarcoma? | high grade, close margins, or tumor >5 cm
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|
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| What genes are associated with breast cancer? | p53, bcl-2, c-myc, c-myb, her2neu
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|
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| What is the mechanism of ulcer formation with chronic NSAID use? | Inhibits prostaglandin synthesis, causing decreased mucus and bicarb secretion and increased acid production
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| What are the types of wounds and their respective wound infection rates? | Clean (hernia) - 2%; Clean-contaminated (prepped colon resection) - 3-5%; Contaminated (GSW to colon with repair) - 5-10%; Gross contamination (abscess) - 30%
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| What are common causes of GIB in HIV? | Lower > Upper; Upper - Kaposi sarcoma, lymphoma; Lower - CMV, bacterial, HSV
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|
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| What is Comedo breast cancer? What is the treatment? | Most aggressive subtype of DCIS, has necrotic areas, high risk of microinvasion and recurrence; Rx - mastectomy
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| What is Paget's disease of the breast? Treatment? | Scaly skin lesion on nipple, suggesting underlying DCIS or ductal CA; Rx - MRM if cancer present, simple mastectomy if not
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| What are the indications for chemotherapy in breast cancer? | >1 cm tumor or positive nodes (except postmenopausal women with positive estrogen receptors -> tamoxifen)
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|
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| Describe the relevant anatomy of the diaphragm | T8 - vena cava; T10 - esophagus + vagus; T12 - aorta + thoracic duct
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| When do you resect a thymoma? | All require resection, 50% are malignant
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|
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| What do you suspect with a pansystolic murmur 2-7 days after an MI? | Post-MI VSD
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|
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| What is the anatomy of the thoracic duct? | Enters chest on right with aorta at T12, crosses to left at T4, then joins left subclavian at junction with IJV
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|
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| What are the types and treatment of aortic dissections? | Stanford: A = involves ascending, always needs surgery; B = does not involve ascending, medical management unless persistent pain or end-organ ischemia
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|
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| What is the most common congenital heart defect? | Ventricular septal defect
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|
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| Which hormones are involved in paraneoplastic syndromes of: squamous cell lung CA? small cell lung CA? | Squamous cell - PTH-related peptide; Small cell - ACTH (most common), ADH
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|
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| What is a catamenial pneumothorax? | PTX occurring in temporal relation to menstruation, caused by endometrial implants in visceral lung pleura
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|
||||
| What are the most common types of anal canal tumors? | Squamous cell (AKA epidermal, basaloid, cloacogenic, transitional), Adenocarcinoma, and melanoma
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|
||||
| What is the treatment for a low T2 rectal carcinoma? | APR or LAR (need 2cm margin from levator muscles for LAR)
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|
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| What is pyoderma gangrenosum? What is the treatment? | Painful raised pustules on skin with necrotic center which progress to spreading ulceration - a/w IBD; Rx - local wound care, steroids, dapsone
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| Which extraintestinal manisfestations of UC do not improve after colectomy? | Primary sclerosing cholangitis and ankylosing spondylitis
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|
||||
| What does manometry showing normal LES tone but strong unorganized contractions suggest? What is the treatment? | Diffuse esophageal spasm; Rx - Ca channel blockers and nitrates
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|
||||
| What does manometry showing increased LES pressure, incomplete relaxation, and no peristalsis suggest? What is the treatment? | Achalasia; Rx - Ca channel blockers and LES dilation first (60% effective), if fail - Heller myotomy (LES circular muscle transection) + Nissen
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| What is the most commonly injured nerve with parotid surgery? | Greater auricular nerve - numbness over lower portion of auricle
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|
||||
| How does clopidogrel (Plavix) affect platelets? | ADP receptor antagonist
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|
||||
| What is the most common cause of a spontaneous intestinal fistula? | crohn's disease
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|
||||
| What is the most common site of GI lymphoma? | stomach
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|
||||
| Which segment of the liver drains directly into IVC? | Segment I - caudate lobe
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|
||||
| What is the initial treatment of GI bleeding in Mallory-Weiss syndrome? | Observation - most cases stop with nonoperative management
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|
||||
| For what condition is the risk of overwhelming postsplenectomy sepsis highest? | Thalassemia
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|
||||
| What is the most common cause of hypercalcemic crisis? | malignancy
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|
||||
| What does the sudden onset of glucose intolerance in a patient receiving TPN indicate? | sepsis
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|
||||
| What vitamin deficiency causes dermatitis, diarrhea and dementia? | Niacin - this syndrome is called Pellegra
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|
||||
| What can enhance immune function in critical illness? | arginine
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|
||||
| What is an effect of stored blood? | Decreased 2,3-DPG - leftward shift of oxygen disassociation curve
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|
||||
| What is the pathophysiology of ITP? | Antiplatelet IgG originating in the spleen
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|
||||
| What hematologic disease has the highest morbidity after splenectomy? | Myeloid dysplasia
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|
||||
| What vitamin deficiency causes dermatitis, hair loss, and thrombocytopenia? | Essential fatty acid deficiency
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|
||||
| What is the most common complication of heparin reversal with protamine? | Hypotension
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|
||||
| What is the optimal treatment for bleeding gastric varices in chronic pancreatitis? | Splenectomy
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|
||||
| What does a RQ >1 indicate? What does a RQ <0.7 indicate? | >1 = lipogenesis (overfeeding); <0.7 = ketosis and fat oxidation (starving)
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|
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| What is fetal wound healing characterized by? | increased hyaluronic acid synthesis
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|
||||
| What is the most common cause of hypercalcemia in breast cancer? | Parathyroid Hormone Related Peptide (PTHrP
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|
||||
| Which nerve injury results in foot drop? Which nerve injury results in decreased foot eversion? | Foot drop = deep peroneal nerve
Foot eversion = superficial peroneal nerve
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|
||||
| Lateral neck mass in infancy with rotation of the head Treatment? | congenital torticollis
Treatment = physical therapy, rarely surgical resection of muscle
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