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Absite killer plus
| Question | Answer |
|---|---|
| What is the source of fever in atelectasis? | Alveolar macrophages |
| What is the first sign of malignant hyperthermia? | Increase in end-tidal CO2 |
| What is the treatment for malignant hyperthermia | Dantrolene |
| What is the first muscle to recover from paralytics? | Diaphragm |
| What is the rate-limiting step in cholesterol formation? | HMG coA Reductase |
| Where is angiotensin I converted into angiotensin II? | lung |
| What are the effects of angiotensin II? | Vasoconstriction Increases aldosterone (keeps Na, loses K/H in urine) |
| 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" |
| Which cells produce pepsinogen? | Chief cells |
| Which cells produce intrinsic factor? | Parietal cells |
| What are the main stimuli for H+ production in the stomach? | Acetylcholine, gastrin, and histamine |
| What is the mechanism of omeprazole? | Blocks H/K ATPase of parietal cell |
| What is the most common symptom post-vagotomy? | Diarrhea (35%) |
| What is the cause of early (15-30 min) dumping syndrome? | Hyperosmotic load, fluid shift causes neuroendocrine response, peripheral and splanchnic vasodilation |
| What is the cause of late (2-3 hrs) dumping syndrome? | Increased insulin with decreased glucose |
| What are the 3 actions of CCK? | 1) contract gallbladder 2) Relax Sphincter of Oddi 3) Increase pancreatic enzyme secretion |
| What is the primary stimulus of pancreatic bicarb secretion? | secretin |
| What affects the amount of bicarb in pancreatic secretions? | Flow rate: high flow = high bicarb, low Cl. Slow flow allows more HCO3/Cl exchange |
| 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 |
| What is the key stimulatory hormone of the MMC? | motilin |
| What drug stimulates motilin receptors? | Erythromycin |
| What is the action of Protein C and Protein S? | Protein C degrades active V and VIII. Protein S helps protein C |
| What is the only clotting factor not made in the liver? | Factor VIII (made by reticuloendothelial system) |
| 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 |
| What is the only inherited coagulopathy with long bleeding time? | Von Willebrand's Disease (autosomal dominant) |
| What is the pathophysiology of Glanzman's thombasthenia? | IIb/IIIa receptor deficiency of platelets. Decreased platelet aggregation. Fibrin normally links Gp IIb/IIIa receptors |
| 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 |
| What test confirms the presence of von Willebrand Disease? | Ristocetin test |
| What are the three possible treatments for vWD? | DDAVP Factor VIII cryoprecipitate |
| What is the treatment for hemarthrosis in a hemophiliac? | Ice, ROM therapy, Factor replacement Do not aspirate |
| What are the most common inherited thombophilias? | Factor V Leiden Prothrombin mutation (GP20210) Hyper-homocysteinemia |
| What is the treatment for overdose of thrombolytics? | Aminocaproic acid (Amikar) - inhibits fibrinolysis |
| What are the effects of prostacyclin? | Decreased platelet aggregation, vasodilatation, bronchial relaxation |
| What are the effects of thromboxane? | Increased platelet aggregation, vasoconstriction, bronchial constriction |
| What stimulates B cells to become plasma cells? | IL-4 |
| Which complements are anaphylatoxins? | C3a, C5a |
| Which complements make up the membrane attack complex? | C5-9 |
| What cells are responsible for immunosurveillance against CA? | Natural killer cells |
| What is the source of histamine in blood? | Basophils |
| What is the source of histamine in tissue? | Mast cells |
| What is endotoxin? Where does it come from? | Lipopolysaccharide A from gram negative bacteria |
| What does an elevated mixed venous oxygen saturation (SvO2) indicate? | >77% - sepsis or cyandide poisoning |
| What does a low mixed venous oxygen saturation (SvO2) indicate? | <66% - decreased CO |
| What are the four intraabdominal abscess locations? | sub-diaphragmatic sub-hepatic inter-loop pelvic |
| What two infections can present within hours post-op? | B-strep Clostridial (GPR) |
| What is the mechanism of vancomycin? What is the mechanism of it's resistance? | Inhibits cell wall synthesis Altered cell wall (unable to bind) |
| What is the mechanism of quinolones? | DNA gyrase inhibition |
| What is the mechanism of amphotericin | binds sterols to alter fungal cell wall |
| What antibiotic prolongs neuromuscular blockade? | Clindamycin |
| What are the risks of a blood transfusion? | CMV is highest Hep C 1:30-150,000 HIV 1:500,000 |
| What are the vitamin K dependent factors? | II, VII, IX, X, protein C + S |
| Which antibiotics are bacteriocidal, with irreversible binding to 30S ribosome subunit, and resistance due to decreased active transport? | Aminoglycosides (gentamicin, neomycin, tobramycin) |
| What is the only depolarizing neuromuscular blocker used? | Succinylcholine |
| What is an adverse effect of succinylcholine in burn patients? | hyperkalemia |
| What are the effects of reglan (metoclopramide)? | Dopamine receptor blocker - Increases LES tone and gastric motility |
| What is the mechanism of digoxin? | inhibits Na/K ATPase to increase calcium in heart |
| What is the effect of digoxin? | Slows AV conduction, inotrope but does not increase O2 consumption |
| What pressor is most useful in GIB? | Vasopressin: reduces splanchnic blood floow, portal flow ~40%. Give with B-blocker to avoid angina |
| What gastric contents have the highest concentration of K? | Saliva (20 meq) > gastric (10 meq) > pancreatic/duodenal (5 meq) |
| 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) |
| What drug can reverse adverse effects of steroids on wound healing? | Vitamin A |
| How many kcal/g are in protein, fat, and carbs? | Protein: 4 kcal/g Fat: 9 kcal/g Carbs: 3.4 kcal/g |
| Describe vitamin D synthesis | Vit D made in skin, to liver for (25-OH, calcidiol), then to kidney for (1-OH, calcitriol), then active |
| What is the respiratory quotient? | Ratio of CO2 produced to O2 consumed 0.7 = fat used 1.0 = carb used |
| What is the preferred fuel of the colon? | Short chain fatty acids - butyric acid |
| 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 |
| What is the preferred fuel of the small bowel? | Glutamine |
| What is the #1 amino acid in the blood stream? | Glutamine |
| What causes a decrease in glutamine in the blood stream during stress? | Glutamine goes to kidney to form ammonium to help acidosis |
| What vitamin deficiency causes hyperglycemia (relative diabetes) and neuropathy? | Chromium |
| What vitamin deficiency causes perioral rash, hair loss, poor healing, and change in taste? | Zinc |
| What vitamin deficiency causes weakness (respiratory) and encephalopathy? | Phosphate (needed for ATP) |
| What vitamin deficiency causes anemia and neutropenia? | Copper |
| Describe the Cori cycle | glucose to lactate, to the liver, to glucose |
| During starvation, what does the brain use for fuel? | ketones from fatty acids (instead of glutamine) |
| 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 |
| What two electrolyte abnormalities cause hyperexcitability (increased reflexes, tetany)? | Hypocalcemia and hypomagnesemia |
| How does magnesium affect calcium? | Low Mg inhibits PTH, so replace MG if difficulty correcting Ca |
| What are the phases of the cell cycle? | G1 - most variable period; S - DNA replication; G2; M - Mitosis |
| What phase of the cell cycle is most sensitive to radiation therapy? | M - mitosis |
| 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) |
| What is a complication of bleomycin and busulfan? | pulmonary fibrosis |
| What are the risks of tamoxifen? | DVT and Endometrial cancer |
| 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 |
| What is a side effect of vincristine and cisplatin? | Neurotoxicity |
| What cells provide wound contraction? | Myofibroblasts |
| What cells are responsible for healing by secondary intention? | Myofibroblasts |
| What is the principal collagen late in scar? | Type I |
| What is the principal collagen in a healing wound? | III (this is the collagen of granulation tissue) |
| What type of collage is low in Ehler-Danlos? | III |
| 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 |
| What is the order of cells to a healing wound? | Platelets PMNs macrophages (essential) fibroblasts (dominant by day 5) |
| What are the effects of TGF-B? | stimulates fibroblasts and chemotactic for neutrophils (too much/too long can cause fibrosis) |
| What is the effect of PDGF? | Attracts fibroblasts and increases smooth muscle to speed matrix deposition and collagen formation |
| What is the main source of TNF? | Macrophage/monocyte |
| What cell does TNF recruit and activate? | neutrophils |
| How does TNF cause wasting/cachexia in cancer patients? | Anorexia, glycolysis, and lipolysis |
| 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 |
| What is Poland's syndrome? | Amastia, hypoplastic shoulder, no pectoralis |
| What is Mondor's disease? What is the treatment? | thrombophlebitis of superficial vein of breast. Cord like mass laterally. Treat with NSAIDS |
| Describe the "T" staging of breast cancer | T1 = <2cm T2 = 2-5cm T3 = >5cm T4 = skin or chest wall involvement |
| 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) |
| 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 |
| How does hormone receptor status in breast cancer affect prognosis? | ER+PR+ > ER-PR+ > ER+PR- > ER-PR- |
| What % of DCIS develop invasive cancer? | 50% |
| What % of LCIS develop invasive cancer? | 30-40% (in either breast) |
| What is the difference pathophysiologically in cancer risk between DCIS and LCIS? | DCIS is a precursor to cancer LCIS is a marker of risk |
| What % of Phyllodes tumor are malignant? | 10% |
| What is the treatment for Phyllodes tumor? | Wide local excision, rarely mastectomy. No axillary node dissection necessary (spread is hematogenous, not lymphatic) |
| What type of cancer is BRCA1 and BRCA2 associated with? | BRCA1 - ovarian CA (50%) BRCA2 - male breast CA |
| What are the indication for RT after mastectomy? | >4 nodes skin or chest wall involvement +margins |
| 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 |
| What is the #1 cause of blood nipple discharge? | Intraductal papilloma - no risk of CA |
| 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 |
| What is the difference between the two types of alveoli? | Type I: functional gas exchange Type II: produce surfactant (1% of alveoli) |
| 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% |
| Popcorn lesion on CXR | hamartoma |
| What are the indications for CABG? | intractable symptoms >50% left main triple vessel disease 70% LAD + 1 other vessel |
| 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 |
| 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) |
| What electrolytes are actively secreted by the colon? | K and HCO3 |
| Describe the blood supply of the rectum | Superior rectal artery off IMA Middle off internal iliac Inferior off internal pudendal (off internal iliac) |
| What are the most common genetic mutations in colon cancer? | p53 (85%), DCC (70%), ras (50%) |
| Amsterdam criteria | 3 1st generation relatives, over 2 generations, 1 diagnosed before age 50 |
| Gardner's syndrome | colon CA and desmoid tumors |
| Turcot's syndrome | colon CA and brain tumors |
| Peutz Jeghers | polyposis and mucocutaneous pigmentation; increased risk of GI, gonadal, breast cancers |
| What gene is associated with sacroiliitis in IBD? | HLA B27 |
| Where are most anal fissures located? | posterior midline, 10% are anterior in women |
| What are the causes of anal fissures which are lateral or recurrent? | IBD, TB, or syphilis |
| What is normal LES tone and length? | 15-25 mm Hg, 4cm long, 40cm from incisors |
| What is the treatment of diffuse esophageal spasm? | calcium channel blockers |
| What is the pathophysiology of achalasia? | Decreased ganglion cells in Auerbach's plexus, absence of peristalsis and esophageal dilation. High LES pressures |
| What is main arterial supply to stomach when used to replace esophagus? | right gastroepiploic artery |
| 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 |
| 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 |
| What is a painless mass on the roof of the mouth? | Torus - bony exotosis, midline of palate |
| Which has a greater risk for cancer, leukoplakia or erythroplakia? | Erythroplakia |
| 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 |
| What is the treatment for glottic Ca? | If cords not fixed, then RT If cords fixed, need surgery and RT |
| What is the most common type of lip cancer? | Epidermoid carcinoma. Lower > upper due to sun exposure |
| What is the usually presentation of nasopharyngeal carcinoma? | 50% presesnt late (as neck mass). Drain to posterior neck nodes. A/w EBV |
| What is the treatment of lip cancer? | Resect, primary closure if <1/2 of lip, otherwise flaps. Radical neck dissection if node+ |
| 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 |
| What are the most common malignant salivary gland tumors? | #1 - Mucoepidermoid carcinoma #2 - Adenoid cystic carcinoma (#1 of submandibular and minor glands) |
| What are the most common benign salivary gland tumors? | Pleomorphic adenoma (#1 overall), Warthin tumor |
| 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 |
| 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) |
| 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 |
| 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%) |
| What are Kupffer cells? | Specialized macrophages in the liver responsible for clearing portal blood and immunosurveillance. Also responsible for early alcohol-induced liver injury. |
| Describe the anatomical relationship of the Portal triad | Portal vein posterior to CBD (on R) and hepatic artery (on L) |
| What is the #1 cause of benign biliary stricture? | Iatrogenic (lap chole) |
| 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 |
| 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 |
| What is the triad of hemobilia? | UGIB, RUQ pain, and jaundice - caused by fistula between biliary duct and hepatic arterial system |
| What is the treatment of hemobilia? | workup and treatment with arteriogram |
| How does the gallbladder concentrate bile? | Active absorption of Na, Cl (H20 then follows) |
| What is the treatment for hepatic adenoma? | Hepatic adenoma is an indication for resection 10% rupture/bleed + malignant potential |
| What is the treatment for hepatic hemangioma? | Do nothing unless giant or symptomatic/consumptive |
| What is Kasabach-Merritt syndrome? | Consumptive coagulopathy or CHF due to hemangioma - usually in infants. |
| What is the treatment of liver amebic abscess? | metronidazole, not surgical |
| What is the treatment of hydatid cysts? | Surgical resection with chemotherapy before and after (albendazole or mebendazole) |
| What is the work-up of hydatid cysts? | Casoni skin test + Indirect hemagglutination |
| 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 |
| What type of HCC has best prognosis? | Fibrolamellar |
| 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 |
| What triggers ADH release? | Produced when high osmolarity is sensed at supraoptic nucleus of hypothalamus |
| What is Diabetes Insipidus? | Alcohol and head injury inhibit ADH release - high UOP, low urine SG, high serum osmolarity/Na |
| What is SIADH? | Increased ADH release most often by head trauma/tumors or SCLC. Oliguria, high urine osmolarity, low serum osmolarity/Na |
| What is the effect of ADH? | Causes increased free water absorption at the distal tubules and collecting ducts and increases peripheral vascular resistance |
| What is cerebral perfusion pressure? | Mean Arterial Pressure (MAP) - Intracranial Pressure (ICP) Keep ~70 |
| What is Cushing's triad? | Hypertension, bradycardia, and Kussmaul respirations (slow, irregular) associated with increased ICP |
| 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 |
| What are the signs of spinal shock? | Hypotension with bradycardia, warm perfused extremities (vasodilation) Cord injury above T5 |
| What are the deficits in anterior spinal artery syndrome? | Lose bilateral motor, pain, and temperature. Keep position sense, light touch |
| What is Brown-Sequard syndrome? | Spinal cord hemi-transection Lose ipsilateral motor, contralateral pain and temperature |
| 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 |
| What are the indications to operate on a skull fracture? | If open or depressed |
| What are the effects of L3-L4 disc herniation? | L4 root compresson - quadriceps, week knee jerk |
| What are the effects of L4-L5 disc herniation? | L5 root compression - foot drop, possible big toe hyperesthesia |
| 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 |
| What is the terrible triad of O'Donaghue? | lateral blow to knee - injury to ACL, MCL, medial meniscus |
| What does the medial nerve do? | thumb apposition, sensation to most of palm, 1st 2 1/2 fingers (carpal tunnel) |
| What does the ulnar nerve do? | intrinsic musculature of hand, finger abduction, wrist flexion, sensation to 2 1/2 fingers/back of hand |
| What does the radial nerve do? | Wrist/finger extension, sensation to back of lateral hand; no motor in hand |
| What are the benefits of early ORIF in femur fracture? | early mobilization decreased fat embolization |
| 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 |
| 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 |
| What ABG values increase the risk of a lung resection? | pCO2 >45 or pO2 <50 at rest |
| What marks the transition between the anal canal and the rectum? | Levator ani |
| 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 |
| What is the most common site of esophageal perforation? | Cricopharyngeal muscle (usually by EGD) |
| 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 |
| What is the normal half-life of: RBCs? PMNs? platelets? | RBC - 120 days; PMNs - 1-2 days; platelets - 7 days |
| What is the mechanism and effect of Amrinone? | Phosphodiesterase inhibitor - inotrope, increases CO and decreases SVR |
| What is a side effect of carbapenems? | Seizures |
| What are side effects of aminoglycosides? | Reversible nephrotoxicity, irreversible ototoxicity |
| What is the mechanism of rifampin? | RNA polymerase inhibitor |
| Which antibiotic can affect platelets? | PCNs and cephalosporins - can bind platelets and increase bleeding times |
| What triggers renin release? | Macula densa senses low Na/Cl |
| What is the mechanism of malignant hyperthermia? | Ca release from sarcoplasmic reticulum |
| What does antithrombin III do? | binds to and inhibits thrombin; inhibits factors IX, X, XI. Heparin binds this |
| How do you calculate nitrogen balance? | N balance = N in - N out = Protein/6.25 - (24 hr urine N + 4g) |
| What converts natural killer cells to lymphokine activated killer cells? | IL-2 |
| What is the mechanism of metronidazole? | produces oxygen radicals that breakup DNA |
| What are the effects of ketamine? | increases cardiac work, O2 use, secretions, and BP; no respiratory distress; hallucinations possible |
| What are side effects of vancomycin? | Redman syndrome (histamine release), nephrotoxicity, ototoxicity |
| What are side effects of metronidazole? | Disulfiram-like reaction, peripheral neuropathy |
| What are 3 laboratory indications of low volume, "pre-renal" | FeNa <1, Urine Na <20, BUN/Cr >30 |
| What is the function of peptide YY? Where is it secreted? | inhibits acid secretion, "ileal break"; released from terminal ileum |
| How does prostate surgery affect clotting? | Can release urokinase -> activates plasminogen -> thrombolysis |
| How do sequential compression devices work? | Improve venous return and release tPA -> induce fibronolysis |
| What are the side effects of halothane? | renal and liver toxicity |
| What fractures are associated with non-union? | clavicle, 5th metatarsal fracture |
| Which organisms are carbapenems least effective against? | MEPP: MRSA, enterococcus, proteus, pseudomonas |
| What are indications for radiation to an extremity sarcoma? | high grade, close margins, or tumor >5 cm |
| What genes are associated with breast cancer? | p53, bcl-2, c-myc, c-myb, her2neu |
| What is the mechanism of ulcer formation with chronic NSAID use? | Inhibits prostaglandin synthesis, causing decreased mucus and bicarb secretion and increased acid production |
| 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% |
| What are common causes of GIB in HIV? | Lower > Upper; Upper - Kaposi sarcoma, lymphoma; Lower - CMV, bacterial, HSV |
| 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 |
| 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 |
| What are the indications for chemotherapy in breast cancer? | >1 cm tumor or positive nodes (except postmenopausal women with positive estrogen receptors -> tamoxifen) |
| Describe the relevant anatomy of the diaphragm | T8 - vena cava; T10 - esophagus + vagus; T12 - aorta + thoracic duct |
| When do you resect a thymoma? | All require resection, 50% are malignant |
| What do you suspect with a pansystolic murmur 2-7 days after an MI? | Post-MI VSD |
| 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 |
| 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 |
| What is the most common congenital heart defect? | Ventricular septal defect |
| 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 |
| What is a catamenial pneumothorax? | PTX occurring in temporal relation to menstruation, caused by endometrial implants in visceral lung pleura |
| What are the most common types of anal canal tumors? | Squamous cell (AKA epidermal, basaloid, cloacogenic, transitional), Adenocarcinoma, and melanoma |
| What is the treatment for a low T2 rectal carcinoma? | APR or LAR (need 2cm margin from levator muscles for LAR) |
| 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 |
| Which extraintestinal manisfestations of UC do not improve after colectomy? | Primary sclerosing cholangitis and ankylosing spondylitis |
| 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 |
| 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 |
| What is the most commonly injured nerve with parotid surgery? | Greater auricular nerve - numbness over lower portion of auricle |
| How does clopidogrel (Plavix) affect platelets? | ADP receptor antagonist |
| What is the most common cause of a spontaneous intestinal fistula? | crohn's disease |
| What is the most common site of GI lymphoma? | stomach |
| Which segment of the liver drains directly into IVC? | Segment I - caudate lobe |
| What is the initial treatment of GI bleeding in Mallory-Weiss syndrome? | Observation - most cases stop with nonoperative management |
| For what condition is the risk of overwhelming postsplenectomy sepsis highest? | Thalassemia |
| What is the most common cause of hypercalcemic crisis? | malignancy |
| What does the sudden onset of glucose intolerance in a patient receiving TPN indicate? | sepsis |
| What vitamin deficiency causes dermatitis, diarrhea and dementia? | Niacin - this syndrome is called Pellegra |
| What can enhance immune function in critical illness? | arginine |
| What is an effect of stored blood? | Decreased 2,3-DPG - leftward shift of oxygen disassociation curve |
| What is the pathophysiology of ITP? | Antiplatelet IgG originating in the spleen |
| What hematologic disease has the highest morbidity after splenectomy? | Myeloid dysplasia |
| What vitamin deficiency causes dermatitis, hair loss, and thrombocytopenia? | Essential fatty acid deficiency |
| What is the most common complication of heparin reversal with protamine? | Hypotension |
| What is the optimal treatment for bleeding gastric varices in chronic pancreatitis? | Splenectomy |
| What does a RQ >1 indicate? What does a RQ <0.7 indicate? | >1 = lipogenesis (overfeeding); <0.7 = ketosis and fat oxidation (starving) |
| What is fetal wound healing characterized by? | increased hyaluronic acid synthesis |
| What is the most common cause of hypercalcemia in breast cancer? | Parathyroid Hormone Related Peptide (PTHrP |
| 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 |
| 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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jclanton82
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