Absite killer plus

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

Quick Absite review

Question Answer
What is the mechanism of vancomycin?
Inhibits cell wall synthesis Altered cell wall (unable to
What is the mechanism of it's
bind)
resistance?
What is the mechanism of quinolones? DNA gyrase inhibition
What is the mechanism of amphotericin binds sterols to alter fungal cell wall
Which antibiotics are bacteriocidal, with
irreversible binding to 30S ribosome
Aminoglycosides (gentamicin, neomycin, tobramycin)
subunit, and resistance due to decreased
active transport?
What vitamin deficiency causes
hyperglycemia (relative diabetes) and Chromium
neuropathy?
What vitamin deficiency causes perioral
rash, hair loss, poor healing, and change Zinc
in taste?
What vitamin deficiency causes
weakness (respiratory) and Phosphate
encephalopathy?
What vitamin deficiency causes anemia Copper
Absite killer plus
and neutropenia?
What two electrolyte abnormalities
cause hyperexcitability (increased
reflexes, tetany)?
What phase of the cell cycle is most
sensitive to radiation therapy?
What are the effects of TGF-B?
What is the effect of PDGF?
Describe the anatomical relationship of
the Portal triad
What is Diabetes Insipidus?
What is SIADH?
What three fractures are prone to
compartment syndrome?
What are the signs of gastrinoma?
What are the symptoms of a
somatostatinoma?
What are the symptoms of a
glucagonoma? Treatment?
What are the symptoms of VIP-oma?
What other abnormalities can a patient
with a tracheoesophageal fistula have?
What are the characteristics of
gastroschisis?
What are the characteristics of
Hypocalcemia and hypomagnesemia
Mitosis
stimulates fibroblasts and chemotactic for neutrophils
(too much/too long can cause fibrosis)
Attracts fibroblasts and increases smooth muscle to
speed matric deposition and collagen formation
Portal vein posterior to CBD (on R) and hepatic artery
(on L)
Alcohol and head injury inhibit ADH release - high
UOP, low urine SG, high serum osmolarity/Na
Increased ADH release most often by head
trauma/tumors or SCLC. Oliguria, high urine
osmolarity, low serum osmolarity/Na
Calcaneous, tibia, supracondyle of humerus
Severe ulcer disease, diarrhea (lipase destruction by
acid, malabsorption, incr secretion)
gallstones steatorrhea pancreatitis
diabetes glossitis stomatitis necrolytic migratory
erythema (presenting problem in 70%) Rx =
streptozocin/doxorubican (selectively destroy alpha
cells) and octreotide (inhibits release)
WDHA syndrome = watery diarrhea hypokalemia
achlorydia
VACTERL - vertebral, anal atresia, cardiovascular,
TEF, esophageal atresia, renal, limb defects -
structures derived from embryonic mesoderm
Congenital abd wall defect, intrauterine rupture of
umbilical cord, no associated defects, lateral (right)
defect, no sac
midline defect, may contain liver or other non-bowel
Absite killer plus
omphalocele?
What is Conn's syndrome?
What is Addison's disease?
What is Cushing's disease?
What is Cushing's syndrome?
What is the classic vision change with
pituitary mass effect?
What is the #1 pituitary adenoma? What
Prolactinoma - galactorrhea, irregular menses
are the symptoms?
What type of cancer demonstrates
"peripheral palisading" of nuclei and
"retraction artifact"
What is the most common cause of flap
venous thrombosis
necrosis?
What type of melanoma has the best
prognosis? worst prognosis?
What is MALT a precursor to?
What drugs peripherally block
conversion of T4 to T3?
What is MEN I?
What is MEN IIa?
What is MEN IIb?
What is the mechanism of azathioprine
(Imuran)?
What is the mechanism of cyclosporine?
contents, frequent anomalies, has peritoneal sac.
hyperaldosteronism = 80% adenoma, 20% bilateral
hyperplasia - HTN, low K, high Na
low aldosterone and glucocorticoids = low Na, high K,
hypoglycemia. Crisis presents similar to sepsis with
hypoTN, fever; steroids are diagnostic and therapeutic
Excessive secretion of ACTH from the anterior
pituitary, usually from a pituitary adenoma. Causes
70% of non-iatrogenic 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
Bitemporal hemianopsia - vision missing in outer half
of both right and left visual fields
Basal cell carcinoma
best = lentigo maligna; worst = nodular
gastric lymphoma - regresses with H. pylori treatment
PTU, Propanolol, Prednisone (& other steroids) and
methimazole
Wermer's syndrome - parathyroid, pancreas, pituitary
(prolactinoma most common)
Sipple syndrome - Parathyroid, adrenal
(pheochromocytoma), and thyroid
Thyroid, adrenal, mucosal neuromas/marfan
6MP derivative, purine analog that acts as an
antimetabolite, decreases DNA synthesis
Calcineurin inhibitor - inhibits mRNA encoding of IL-
2
Absite killer plus
What is the mechanism of blocks purine synthesis to decrease T and B cell
mycophenolate (cellcept)? proliferation
Calcineurin inhibitor - blocks IL-2
What is the mechanism of tacrolimus
expressions/production from T cells - more potent than
(FK506)?
cyclosporine
What is the mechanism of
blocks IL-1 from macrophages
immunosuppression of prednisone?
What is the mechanism of sirolimus mTOR inhibitor - inhibits the response of IL-2 thereby
(Rapamune)? blocking the activation of T and B cells
How does aging affect PFTs? reduces FEV1 and FRC
What are the effects of PEEP on the
Increased FRC, increased compliance
lungs?
What is functional residual capacity
air in lungs after normal exhalation
(FRC)?
maximum amount of air able to be inhaled (TV +
What is inspiratory capacity?
inspiratory reserve volume IRV)
greatest volume that can be exhaled (IRV + TV +
What is vital capacity?
ERV)
What are the characteristics of good activity against candida/pseudomonas, poor
silvadene? eschar penetration. risk of neutropenia
What are the characteristics of mafenide painful, can cause acidosis due to carbonic anhydrase
acetate (sulfamylon)? inhibition
What are the characteristics of silver Can cause hyponatremia and hypochloremia due to
nitrate? leeching of NaCl
What is a side effect of carbapenems? Seizures
What are side effects of
Reversible nephrotoxicity, irreversible ototoxicity
aminoglycosides?
What is the mechanism of
produces oxygen radicals that breakup DNA
metronidazole?
What are side effects of metronidazole? Disulfiram-like reaction, peripheral neuropathy
What vitamin deficiency causes
Niacin - this syndrome is called Pellegra
dermatitis, diarrhea and dementia?
What vitamin deficiency causes
dermatitis, hair loss, and Essential fatty acid deficiency
thrombocytopenia?
Absite killer plus
What does a RQ >1 indicate? What does >1 = lipogenesis (overfeeding); <0.7 = ketosis and fat
a RQ <0.7 indicate? oxidation (starving)
Created by: jclanton82 on 2011-01-28