Duke PA Surgery Final
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| divisions of cerebrum | frontal, parietal, temporal, occipital
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| the most important divider in the cranium. lesions above and below this structure; produce distinctive syndromes, require different diagnostic tests, require different treatment strategies, have different prognosis | tentorium
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| concomitant dysphasia, hemianopia, or focal epilepsy is a __ lesion | supratentorial
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| anorexia nervosa is sometimes mistaken for __ | wasting
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| in infants, prominent sutures, wide tight fontanelle, unuusually large head, vomiting, headache in occipital region and neck, squint is very common | infratentorial mass
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| brain tumors seldom__ | metastasize outside the CNS
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| __ spread the soonest with metastatic brain tumors | lung and renal cancer cells
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| mets to the brain in men generally come from __ | lung, colon, and renal cancers
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| mets to the brain in women generally come from __ | breast, lung, and melanoma
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| when you see mets to the brain get a __ to confirm pathology | biopsy
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| epilepsy that has failed two medications is | medically intractable epilepsy
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| Most common form of partial complex epilepsy arises from the mesial temporal lobe. Removal of this region can now be done with up to __% cure rate and minimal morbidity | 85
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| to reduce risk of damaging language and memory , patients can undergo a __ test. | WADA
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| in the __ test you temporarily paralyze that half of the brain into which it is injected. Patients are shown flash cards and stop talkin or remembering when the sodium amytal sets in, indicating that hemisphere is involved in language and memory | WADA
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| is a seizure ongoing for 30 minutes without stopping, or multiple seizures in succession without sensorium returning to normal between them | status epilepticus
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| Sybarachnoid hemorrhage may block __ causing hydrocephalus | arachnoid villi
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| myelomeningocele, ultrasound - findings are two frontal bones appear convex inward | lemon sign
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| myelomeningocele, ultrasound - findings are elongated and curved posterior fossa secondary to Chiari malformation | banana sign
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| if a myelomeningocele is discovered during pregnancy it is a surgical emergency and requires __ | planned C section with defect closure within 24hrs
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| what is the management of 85% symptomatic carotid stenosis | carotid endoarterectomy
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| name 4 primary risk factors for atherosclerosis | smoking, hypertension, diabetes mellitus, hypercholesterolemia
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| true or false diplopia, syncope, dizziness, vertigo, and paresthesia are symptoms of carotid disease | false
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| what is the cause of Amurosis Fugax | embolization of retinal arteries
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| what is the treatment for AAA | surgery--repair
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| name the 5 P's for symptoms of Acute Arterial Occlusion | pain, pulselessness, pallor, ploikothermia, paresthesias/paralysis
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| what is the most effective treatment for stable claudication | lifestyle modification, smoking cessation, regimented excercise, and medications (Pletal)
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| what is the leading cause of death in Western culture | atherosclerosis
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| what is the result of narrowing of lumen in atherosclerotic disease | distal ischemia, acute thrombosis, downstream embolization
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| name the 3 types of lessions associated with atherosclerotic disease | fatty streaks, fibrous plaques, complex plaques
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| the most common location for atherosclerosis | at a bifurcation
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| what are the secondary risk factors for atherosclerosis | age, family history, male, obesity
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| what cuases pain with PVD | ischemia of muscle tissue
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| name the arteries responsible for claudication pain in the buttocks | distal aorta/common iliac
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| name the arteries responsible for claudication pain in the thigh | external iliac
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| name the arteries responsible for claudication pain in the calf | superficial femoral
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| describe typical pain with claudication | reproducible, exercise induced pain in foot, calf, or buttock
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| vascular physical exam assessment includes | documented pulses at each level, evaluate each level for signs of ischemia and tissue loss
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| Is an arteriography is always necessary for diagnosis of claudication? | only needed if intervention is planned
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| a molecule that can interact with the immune system | antigen
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| peptides prouced by B lymphocytes that attach to foreign material and aid in removing it from the body | antibody
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| cells that display foreign antigen complexed with MHC on its surface. | antigen presenting cell
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| these genes are expressed on the surface of cells in all jawed vertebrates, and display fragments of molecules from invading microbes or dysfunctional cells | major histocompatibility complex MHC
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| are encoded by the MHC genes | Human Leukocyte Antigens HLA
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| circulation peptides that influence behavior of the immune system (IL-2) | cytokines
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| a protein complex of T lymphocytes that can identify MHC molecules | T-Cell Receptor
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| interact with APC MHC II molecules via the TCR release cytokines (primarily IL-2) | CD4 lymphocyte
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| interact with MHC class I molcules (that contain foreign peptides) and can directly kill the foreign cell | CD8 T lymphocyte
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| of the same species | allogenic
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| a test for determining tissue compatibility between a transplant donor and the recipient before transplantation, in which the recipient's serum is tested for antibodies that may react with the lymphocytes or other cells of the donor | crossmatch
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| the preexisting antibodies against HLA antigens in the serum of a potential allograft recipient that reacts with a specific antigen in a panel of leukocytes, with a higher percentage indicating a higher risk of a positive crossmatch (listed as % antib) | panel reactive antibodies PRA
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| a state of immune acceptance without immunosuppression | tolerance
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| MHC I goes with __ | CD8 T cells (8/1=8)
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| MHC II goes with __ | CD4 T cells (8/2=4)
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| what are the 2 allogenic recognition pathways | direct and indirect
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| T-cells and their receptors identify allogeneic MHC molecules. This generates CD8 T cells which causes attack on an organ and therefore rejection | direct allogenic recognition pathway
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| velocity of blood in vessels is determined by use of __ | duplex ultrasound
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| antilymphocyte antibodies used to prevent rejection until maintenance suppression is therapeutic | induction immunosuppression
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| what is the normal value of ABI in the normal patient | >1
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| what is the ABI in a patient with intermittent claudication | .5-.7
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| what is the ABI in a patient with claudication type pain at rest | <0.3
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| the important cytokine to remember from the transplant lecture | IL-2
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| the ratio of the blood pressure in the lower legs to the blood pressure in the arms. Compared to the arm, lower blood pressure in the leg is a symptom of blocked arteries (peripheral vascular disease). | Ankle Brachial Index (ABI)
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| drugs that end in "-mab" are __ | monoclonal antibodies
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| what is the common ABI of DM patients | >1 due to calcified non-compressible vessels
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| what is the best test for determination of atherosclerotic disease status | arteriography
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| indications for surgical intervention in PVD | lifestyle modifications, rest pain, or tissue loss
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| one important complication of lower extremity amputation | MI
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| 80% of claudication patients have __ claudication | stable
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| essential test to obtain prior to referral of PVD patient | NIVT
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| test of choice for carotid artery disease | duplex scan (doppler US)
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| what is the gold standard for diagnosing lesions of aortic arch, carotid artery, vertebral artery, and intracranial artery | four vessel arteriography
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| leading cause of death CEA | cardiac complication
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| what are the indications for AAA repair | >5cm, size increase >0.5cm/yr, symptomatic, rupture
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| most common post op complication of AAA | MI
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| what is the etiology of acute arterial occlusion | thrombosis or embolism
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| name 2 common sites of AAO | lower extremity vessels and diseased vessels
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| what is the leading cancer killer of women and men | lung
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| what type of cancer is associated with asbestos exposure | mesothelioma
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| what is the most aggressive type of lung cancer and is not surgically treated | small cell lung cancer
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| what type of lung acnacer presents most frequently as systemic disease | small cell-highest rate of mets
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| most common type of lung cancer | non-small cell 80%
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| 2 most common types of non-small cell lung cancer | squamous, adenocarcinoma
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| squamous cell lung cancer is usually where in the lung | central
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| adenocarcinoma lung cancer is usually where in the lung | peripheral
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| when a transplanted organ is placed in its normal anatomic location in the recipient | orthograft
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| when a transplanted organ is placed in an area that is not its normal anatomic location in the recipient | heterograft
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| what are the levels for stage 3b | (T4 w/ N0-2), and (T1-4 w/ N3)
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| what are the levels for stage 4 | any T or any N with M1
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| what is the presentation of stage 1 lung cancer | predominately asymptomatic while more advanced is symptomatic
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| what fraction of patients present to PCP with stage 3-4 lung cancer | 2/3
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| what are the most frequent symptoms associated with advanced lung cancer | cough, wt loss, dyspnea, chest pain, hemoptosis, bone pain, lymphadenopathy, hepatomegaly, clubbing, horseness, SVC syndrome
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