aLAPAROSCOPIC SURGERY 1) Which are the 3 methods to confirm intraperitoneal with VERESS NEEDLE TECHNIQUE? 2) Which are the physiologic consequences of LAPAROSCOPIC PNEUMOPERITONEUM? 1) Pressure < 8!!, Inject saline without return, positive hanging drop test. 2) HYPOTENSION, DECREASED CO, AND INCREASED SVR CANCER 1) How do you reduce the malignancy spread in laparoscopic approach? ESOPHAGUS 1) Which is the extension of the HELLER MYOTOMY? ROBOTIC SURGERY 1) Which is the benefit of ARTICULATED ARMS? 1) DECREASE CO2 SPREAD, deflate with trochars in place, use a bag for specimen, removal of all lesions prior deflation 1) 6 CM FROM ESOPHAGUS & 2-3 CM FROM STOMACH!!! 1) INTRACORPOREAL SUTURING (EG PELVIS)!!! ENDOCRINE SURGERY THYROID 1) Which is the most common damaged nerve in thyroidectomy? 2) Which artery is sacrified? 3) To what is associated a RIGHT NONRECURRENT LARYNGEAL NERVE? 4) To what is associated a LEFT NONRECURRENT LARYNGEAL NERVE? 5) 1) EXTERNAL BRANCH OF SUPERIOR Laryngeal Nerve 2) Superior Thyroid artery 3) ARTERIA LUSORIA OR ABERRANR RIGHT SUBCLAVIAN ARTERY 4) RIGHT-SIDE AORTIC ARCH!!! ADRENALS PLASTIC SURGERY ULCERS BREAST ANESTHESIA PHARMACOLOGY ANTICOAGULATION 1) Which is the vascular most critical step during ADRENALECOTOMY? 1) DIVISION OF THE ADRENAL VEINS (RIVC, L- LRENAL VEIN) 1) Which is the best treatment for a STAGE 3 decubitus sacral ulcer? 2) Why not wound vac? 1) Which are the 2 main risk factors for complications in TRAM flaps? 1) Large fasciocutaneous V-TO-Y ADVANCEMENT 2) Only for STAGE 1 and 2 ULCERS 1) OBESITY AND SMOKING 1) Which are the main characteristics of SUCCYNILCHOLINE? 2) 1) What is the PROTAMINE SULFATE? 2) Which is the most common SIDE EFFECT of protamine? 3) For how long should be held Clopidogrel and LMWH before procedure? 4) Which is the MOA of CLOPIDOGREL? 5) How do you reverse it? 6) Which drugs are reversed with 4Factor prothrombin complex concentrate? 1) DEPOLARIZING, Rapid acting & short duration, FASCICULATIONS, increases POTASSIUM, tachycardia in children, METABOLIZED BY PSEUDOCHOLINESTERASE 1) ANTIDOTE FOR HEPARIN OVERDOSE 2) HYPOTENSION 3) Clopidogrel 7 days, LMWH 12 hours, heparin 4-6 hours 4) INHIBITS PLATELET AGG (P2Y2r) IRREVERSIBLE!!! 5) REVERSE WITH PLT TRANSFUSION 6) WARFARIN, APIXABAN AND RIVAROXABAN COLORECTAL COLORECTAL CANCER MICROBIOLOGY 1) Which is the best MARKER for colorectal CA recurrence? 2) Which is the pattern of TUMOR LYSIS SYNDROME? 3) To which tumor is it related TLS? 1) Which toxin of CDiff causes intestinal necrosis and increased permeability? 2) 1) CEA!!! 2) Hematuria, AKI, HyperKalemia, HyperPhosphatemia, hypocalcemia, LEUCOCYTOSIS after chemo 3) NH LYMPHOMA (in Chron + Aza) 1) TOXIN A 1) Which stage is endometrial CA when pelvic LNs are involved? 2) Which is the treatment of stage 3b? 1) STAGE 3B 2) RADIATION AND CHEMOTHERAPY 3) 2) GYN/OB ENDOMETRIAL CANCER VASCULAR SURGERY UPPER EXTREMITY 1) What is effort thrombosis, or PagetSchroetter syndrome? 2) Which is the treatment? 3) Which AAA 1) Which Is the 30-day mortality rate for ENDOVASCULAR and OPEN REPAIR AAA? 1) Which is the most common nerve injured during intervention of short saphenous vein at the level of the calf? 2) What does it innervate? LOWER EXTREMITY GASTRO HISTOLOGY 1) Which PUMP from the PARIETAL CELL secretes HYDROCHLORIC ACID? 1) Is an AxillarySubclavian vein thrombosis due to compression of the subclavian vein by a cervical rib or muscle. 2) Thrombolytic therapy first, then balloon angiography and at last removal of the rib to decompress. 1) 1.6% for endovascular and 4.8% for open one. 1) SURAL NERVE 2) Lateral and posterior calf, ankle, foot 1) The H+/K+ ATPase PUMP!!! ESOPHAGEAL PERFORATION GASTRINOMA CHRONIC PANCREATITIS PANCREATIC LACERATION ACUTE PANCREATITIS WOUNDS NUTRITION 1) Which study should be done in an hemodynamically stable patient with HIGH suspicion of ESOPHAGEAL PERFORATION? 2) What if no findings but still HIGH suspicion? 1) Which are the main characteristics of GASTRINOMA? 1) In a patient with CHRONIC PANCREATITIS with ISOLATED GASTRIC VARICES, what should you suspect? 1) Which 2 criteria are used to REMOVE pancreatic drains? 1) Which are the main FINDINGS in SEVERE ACUTE PANCREATITIS? 2) Which are the 3 evidences of RETROPERITONEAL Hemorrhage in acute pancreatitis? 1) Which are the contaminated wound categories and which is the appropriate closure? 2) When is delayed closure of the fascia needed? 3) Which is the treatment for an EARLY FASCIAL DEHISCENCE? (SALMONCOLORED FLUID) 1) 1) ESOPHAGOGRAPHY WITH WATER SOLUBLA CONTRAST + start abx 2) FLEXIBLE ESOPHAGOSCOPY 1) 80% SPONTANEOUS, 20% MEN1, commonly found near DUODENUM, MALE preponderance. 1) SPLENIC VEIN THROMBOSIS LEADING TO BLEEDING… PERFORM SPLENECTOMY!!! 1) OUTPUT & AMYLASE LEVEL (IF 3 TIMES OVER SERUM AMYLASE, THERE IS A FISTULA!!!) 1) Necrosis of at least 1/3 of pancreas, HYPOTENSION <90, RENAL FAILURE Cr >2.9, GI BLEEDING, RESP FAILURE PaO2 <60, local complications as: hemorrhage, abscess, pseudocyst. 2) PERIUMBILICAL-CULLEN, FLANK – GREY-TURNER, INGUINAL – FOX 1) III and IV, contaminated and dirty. Tx is closure of the fascia but delayed primary closure of the skin (due to contamination. 2) If damage control lap, acidosis or hemodynamic instability. 3) URGENT WOUND EXPLORATION IN OR!!! 1) LIVER BILLIARY TRACT 1) Which is the treatment for HEPATORENAL SYNDROME? 2) Which patients should receive always this treatment? 1) Which are the 3 US findings of A CHOLECYSTITIS? 2) Which is the diameter of CBM in obstruction? 3) Which is the ETIOLOGY of ACALCULOUS CHOLECYSTITIS? 4) What is the INITIAL TX for BILE DUCT injuries of <72 hrs? 5) What is the INITIAL TX for BILE DUCT injuries of >72 hrs? 6) Which treatment should be given first in cases of COMPLETE TRANSECTION OR OCCLUSION (E1,E2)? 7) Which are the INDICATIONS for TRANCYSTIC COMMON BILE DUCT EXPLORATION? 8) Which are the risks of TRANSDUCTAL CBD EXPLORATION? 9) Which is the next step in tx if during a cholecystectomy there is an ABERRANT DUCT FROM THE CYSTIC DUCT? 10) Which are the clinical findings of SPHINCTER OF ODDI DYSFUNCTION? 11) Which is the DX GOLD STANDARD? 1) ALBUMIN + VASOCONSTRICTOR (midrodine + ocreotide) (to decrease vasodilation and increase renal bloodflow) 2) Patients with SBP (ascites + altered mental status) 1) PERICHOLECYSTIC FLUID, WALL THICKNESS >4MM, STONE AT THE NECK 2) > 7MM 3) BILE STASIS -> FAST LITHOGENICITY, DISTENSION OF WALL, ISCHEMIA OF WALL!!! 4) PRIMARY REPAIR OR HEPATICOJEJUNOSTOMY 5) Drainage, sepsis control and stabilize. 6) PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAPHY and PERCUTANEOUS TRANSHEPATIC BILLIARY DRAIN PLACEMENT 7) SUSPECTED CBD STONE IN IOC or PROVEN STONE when IOC is not possible (allergy, pregnancy) 8) Bile leak, biliary stricture, pancreatitis (only used when the latter one fails). 9) INTRAOPERATIVE CHOLANGIOGRAM (FROM THE CYSTIC DUCT)!!!! 10) PERSISTENT RUQ ABD PAIN YEARS AFTER CHOLECYSTECTOMY!!! 11) MANOMETRY!!! 12) ERCP!!! 13) PRIMARY DUCT STONES OF PIGMENTED CALCIUM BILIRRUBINATE!!!! 14) SIMPLE LIGATION OF DUCT AND PLACEMENT OF A DRAIN!!! 15) TUBE CHOLANGIOGRAM TO EVALUATE BILIARY DUCTS 16) CHOLECYSTECTOMY IN 6-8 WEEKS!!! 12) Which is the tx for POSTCHOLECYSTECTOMY CHOLEDOCOLITHIASIS? 13) Which kind of stones does it have? 14) Which is the tx of BILE DUCT INJURY if <3mm in diameter? 15) Which is the mx of CHOLECYSTOSTOMY TUBE in POOR SX CANDIDATES? 16) Which is the mx of CHOLECYSTOSTOMY TUBE in GOOD SX CANDIDATES? 17) Which is the composition of PRIMARY COMMON BILE DUCT STONES? 18) Which is the composition of secondary bile duct stones (gallbladder) 19) Which is the tx for GALLBLADDER CANCER TYPE 1B OR MORE? 20) And if Type 1A? 21) Which is the best INITIAL STUDY for ACUTE CHOLANGITIS or CHOLELITHIASIS? 22) Which is the minimum indicated liver remnant after hepatectomy? 23) Which is the tx for abscess of <3cm!!! after a lap appy? 24) And if >3cm? 25) Which is the source of BACTERIAL PERITONITIS in a px with recent BOWEL RESECTION + CHRONIC STEROID USE? 17) CALCIUM BILLIRUBINATE AND CHOLESTEROL!!! (brown pigment stones-infext) 18) Cholesterol stones or calcium billirubinate (black pigment from hemolytic disorders)!!! 19) LIMITED HEPATIC RESECTION OF SEGMENTS IVB AND B + PORTAL LYMPHADENECTOMY WITH COMMON BILE DUCT RESECTION, AND ROUX-EN-Y RECONSTRUCTION 20) Cholecystectomy alone is OK! 21) ABDOMINAL ULTRASOUND!!! 22) 20% if healthy, 30% if dysfunction, 40% if cirrhosis 23) IV ANTIBIOTICS 24) PERCUTANEOUS DRAINAGE!!! 25) SECONDARY BACTERIAL PERITONITIS by ANASTOMOTIC LEAK!!! 26) FIBROSIS AND THICKENING OF THE GALLBLADDER!!! GERD ERCP ABDOMEN – CANCER 26) Which are the US findings of CHRONIC CHOLECYSTITIS? 1) Which is the most common complication of CHRONIC GERD? 2) Which anatomic structures and incised when doing a NISSEN FUNDUPLICATION? 3) How is the ENDOSCOPIC SURVEILLANCE for BARRET WITH LOWGRADE DYSPLASIA? 4) Which is the most common complication of HELLER MYOTOMY? 5) What do you do to avoid it? 1) When is the patient ROTATED TO PRONE POSITION? 2) Which endoscope is used that provides best view of the AMPULLA OF VATER? 3) Which is the position of the AMPULLA OF VATER? 4) Which is the position of the COMMON BILE DUCT ORIFICE in the ampulla? 5) Which is the position of the PANCREATIC DUCT in the ampulla? 1) Which are the risks factors of PERITONEAL MESOTHELIOMA? 2) Which are its CLINICAL FINDINGS? 3) Which is the tx? 4) Which is the tx for GALLBLADDER CANCER if > T1b (tumor invades muscular layer or more)? 1) SHORTENING OF THE ESOPHAGUS!!! 2) SHORT GASTRIC VESSELS!!! (Tension free wrap, decreases risk of dysphagia). 3) EVERY 6 MO FOR ONE YEAR, THEN YEARLY!!! 4) REFLUX 5) PARTIAL FUNDUPLICATION!!! 1) When SCOPE IS IN PLACE IN THE SECOND PORTION OF THE DUODENUM. 2) A SIDE-VIEW ENDOSCOPE!! ! 3) AT 12 OR 1 O’CLOCK 4) 11 O’CLOCK!!! 5) BETWEEN 1 TO 3 O’CLOCK!!! 1) ASBESTOS EXPOSURE + SHIPYARD JOB 2) CARCINOMATOSIS SYNDROME: DIFFUSE ABDOMINAL PAIN + WEIGHT GAIN + INCREASED ABD GIRTH 3) Cryored sx and hypertherminc intraperitoneal chemo. 5) Which is the first step in TX for a RUPTURED APPENDICEAL MUCINOUS ADENOCARCINOMA? 6) Which is the second step? 7) HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY (HIPEC) is only effective if? 8) Which is the appropriate cancer surveillance in pxs with PRIMARY SCHLEROSING CHOLANGIITIS? 9) Which is the most common origin of PSEUDOMYXOMA PERITONEII? 10) Which is the first line treatment of ovarian pseudomyxoma peritonei? 11) Which is the best initial dx study for an UNILATERAL TESTICULAR MASS? 12) Which condition is associated with DESMOID TUMORS? 13) CYTOREDUCTIVE SX is most effective in which type of PERITONEAL CARCINOMATOSIS? 14) Which are the most common tumors in von Hippel-Lindau syndrome? 15) Which is the best TX for hypoglycemic episodes due to INSULINOMA? 16) Which tumor causes CHOLELITHIASIS, 4) RE-RESECTION + HEPATIC RESECTION OF 4 & 5B + PORTAL LYMPHADENECTOMY 5) APPENDECTOMY + DX LAPAROSCOPY 6) CRYORX SX: RIGHT HEMICOLECTOMY, RIGHT LOWER QD PERITONEAL RX, OMENTECTOMY AND HYPERTHERMIC CHEMO!!! 7) COMPLETE CRYOREDUCTION (<2mm) 8) MRI/MR CHOLANGIOPANCREATOGRAPHY EVERY 6 MONTHS (CHOLANGIOCARCINOMA), ANNUAL RUQ US (GALLBLADDER CARCINOMA), COLONOSCOPY EVERY 1-2 YEARS, ANNUAL CA 19-9 9) APPENDIX 10) DEBULKING SX + INTRAPERITONEAL CHEMOTHERAPY 11) DUPPLEX US 12) FAMILIAL ADENOMATOUS POLYPOSIS 13) If MALIGNANT PERITONEAL MESOTHELIOMA!!! 14) CNS and retinal HEMANGIOBLASTOMAS, RENAL CELL CARCINOMA, and PHEOCHROMOCYTOMAS!!! 15) HIGH-CARBOHYDRATE DIET!!! 16) SOMASTOSTINOMA 17) DIARRHEA, HYPOKALEMIA, HYPOCHLORYDRIA ANUS APPENDIX COLON NEURO TUMORS STEATORRHEA, and DIABETES? 17) What does VIPOMA cuase? 1) Which structure is used as a guidance when separating the rectum to the levator ani muscles in a perineal resection? 2) When is sx indicated in rectal cancer? 3) Sx for UPPER RECTUM CANCER? 4) SX for MIDDLE AND LOWER RECTUM? 5) CLOSE TO ANAL SPHINCTERS SX? 6) Within 8cm from anal verge and <3cm? 18) 1) Which is the common age and CT sign of a SIGMOID VOLVULUS? 2) Which is the tx for UNSTABLE PERITONITIS with SIGMOID VOLVULUS? 1) 2) 3) 4) 5) COCCYX Only if STAGE 1 LEFT HEMICOLECTOMY LOW ANTERIOR RESECTION ABDOMINOPERINEAL RESECTION. 6) TRANSANAL LOCAL EXCISION. 18) 1) 70yo, WHIRL SIGN!!! 2) SIGMOIDECTOMY!!! 1) Which Tumor can be thoracic/cervical and cause Horner’s syndrome (ptosis, myosis, anhidrosis)? 2) Which are the characteristics of EPENDYMOMA? 3) Which tumor can cause SEIZURES, SPASTIC WEAKNESS, MOTOR/SENSORY DEFICITS, INCONTINENCE? 1) NEUROBLASTOMA 2) HEADACHE, visual LOSS (PAPILLEDEMA), VOMITING, + BABINSKY 3) MENINGIOMA RESPIRATORY CANCER BREAST CANCER ABSCESS FAT NECROSIS PEDIATRICS BILLIARY 1) Which is the incidence of MESOTHELIOMA? 2) Which lesion gives you TRIGLYCERIDES in PLEURAL fluid? 3) How do you treat LYMPHOMA-related chylothorax? 4) 1) Which is the most common gene mutation implicated in MALE BREAST CANCER? 2) In which chromosome is BRCA2 found? 1) Which is the tx for BREAST ABSCESS? 1) Which are the mammographic findings of FAT NECROSIS 1) Which are the type 3 choledocal cysts? 2) Treatment? 3) Which are the type 4 and five? 4) Treatment? 1) 80% ASBESTOS EXPOSURE, 20% SPONTANEOUS!!! 2) CHYLOTHORAX 3) Conservative measures: Drainage, NPO, TPN, continue chemotherapy 4) 5) 1) BRCA2 2) CHROMOSOME 13 1) US-GUIDED FINE NEEDLE ASPIRATION + ABX 1) SPICULATED MASS, MICROCALCIFICATIONS, ARCH DISTORTION + ALWAYS HX OF TRAUMA!!! 1) INTRAPANCREATIC or INTRADUODENAL dilations of CBD 2) ERCP and MARSUPIALIZATION 3) Four: intra and extrahepatic duct dilations, five only intrahepatic. 4) LIVER TRANSPLANT TRAUMA TRANSPLANT LIVER Complications KIDNEY TRANSPLAN HEMATOLOGY COAGULATION DISORDERS TRAUMA 1) Which is the STANDAR DOSE of CRYSTALLOIDS IN PEDS? 2) Which is the dose of BLOOD in peds? 3) 1) Which score is used to assess severity of liver transplantation? 2) Which are the FOUR parameters included in the MELD SCORE? 3) Which are the 4 ONCOLOGIC CONDIITIONS that can be cured with LIVER TRANSPLANTATION? 4) Which is the most common cause of cholangitis after a liver transplant? 1) Which is the most common cancer after transplant? 1) Which is the first step in management of OLIGURIA after RT? 2) What should be done if PRERENAL and HYPERKALEMIA? 1) Which is the first-line treatment for VWf deficiency? 1) 20mL/kg TWICE 2) 10mL/kg!!! 3) 1) MELD SCORE (Model of End-Stage Liver Diseas) 2) SODIUM, INR, BILIRRUBIN, AND CREATININE 3) HCC (<5CM or 3 <3CM), PERIHILIAR CHOLANGIOCARCINOMA (<3CM AND AFTER NEOAD CHEMO), METASTATIC COLORECTAL CARCINOMA 4) ANASTOMOTIC BILLIARY STRICTURE!!! 1) SKIN CANCER (SCC) 1) DOPPLER AND FLUSH FOLEY OR BLADDER SCAN 2) BOLUS OF LACTATED RINGER (if normal K+ is LR or NS). 1) Type 1 & 2 DESMOPRESSIN, Type 3 – FACTOR VIII/VWf CONCENTRTE. SPLENECTOMY HERNIAS 1) Which splenic ligament has the splenic artery? 2) Which ligament has the SHORT GASTRIC ARTERIES? 1) Which is the tx for CHRONIC INGUINODYNIA after inguinal hernia repair? 2) Which is the best SX APPROACH for LONG STANDING DIAPHRAGMATIC HERNIAS? 3) Which is the best surgical technique to repair a STRANGULATED FEMORAL HERNIA? 4) Which structures does MCVAY joins? 5) Which surgery sutures the cojoint with the inguinal ligament? 6) Which are the borders of the inguinal canal? 7) Which vessels are close and easy to damage on its inferior aspect (INGUINAL LIGAMENT)? 8) Which surgery uses a mesh to reconstruct the inguinal floor? 9) Which are the boundaries of the FEMORAL CANAL? 1) The SPLENORENAL LIGAMENT 2) GASTROSPLENIC LIGAMENT 1) LOCAL ANESTHETIC NERVE BLOCK. IF FAILS: NEURECTOMY + REMOVAL OF MESH!!! 2) THORACOABDOMINAL APPROACH!!! 3) THE MCVAY or COOPER’S REPAIR (repairs the hernia without using a mesh) 4) Sutures the cojoint tendon with the Cooper’s ligament! 5) The BASSINI REPAIR (for direct and indirect inguinal hernias) 6) Inferior: Inguinal ligament/lacunar ligament. Posterior/floor: Cojoint tendon (transv and int oblique). Anterior: Aponeurosis of ext oblique. Superior: ext oblique, int oblique and transversalis aponeurosis. 7) EXTERNAL ILIAC VEIN/ARTERY 8) LICHTENSTEIN REPAIR!!! 9) Anterior: ILIOPUBIC TRACT (or INGUINAL LIGAMENT). Posterior: Pectineus. Medially: Lacunar ligament. RECTUM HEMORRHAGIC SHOCK 10) Which are the boundaries of the INDIRECT INGUINAL HERNIA? 11) Which are the boundaries of the HASSELBACH TRIANGLE (DIRECT INGUINAL HERNIAS)? 12) Which mesh is used if clean or cleancontaminated? 13) Mesh used for grossly spilled contaminated? 14) Posterior boundary of FEMORAL CANAL? 15) Which are the 3 nerves that should be protected in a LICHTENSTEIN HERNIA REPAIR? 16) Which one travels superiorly to the spermatic cord? 17) Which is the primary treatment for RECTUS DIASTESIS? 18) If patient suffers from poor abdominal wall fx, and pulmonary effects, what does the procedure involves? 19) Which is the best technique to repair SUBESTOMAL HERNIAS? 1) Which is the management treatment for EXTRAPERITONEAL RECTAL INJURIES? 1) In class III or IV (30>40% BLOOD LOSS), Laterally: Femoral vein 10) Anterior: Ext. Oblique aponeurosis. Posterior: Conjoint tendon. Medially: Lacunar ligament. 11) Inferior: Inguinal ligament. Medially: Rectus sheath. Lateral: Inferior epigastric artery 12) SYNTHETIC MESH (decreased recurrence, lo infex) 13) BIOLOGICAL MESH 14) PECTINEAL COOPER’S LIGAMENT!!! 15) ILIOINGUINAL, ILIOHYPOGASTRIC, AND GENITAL NERVES!!! 16) ILIOINGUINAL!!! 17) Exercise & weight loss 18) PLICATION OF THE RECTUS!!! 19) SUGARBAKER MESH TECHNIQUE (less recurrence) (second one is the KEYHOLE technique). 1) FECAL DIVERSION AND PRIMARY REPAIR WITH LOOP COLOSTOMYSIGMOID!!!!!!!!! 1) DIRECTLY BLOOD!! MASSIVE what should be transfused? ORTHO UPPER EXTREMITY CARDIOTHORACIC SURGERY AORTIC DISSECTION TRANSFUSION PROTOCOL 1:1 1) Which nerve is damaged in a MIDSHAFT HUMERAL FX? 2) When radial nerve is damaged at the midshaft, which is the clinical finding? 1) RADIAL NERVE 2) WRIST DROP (INABILITY TO EXTEND THE WRIST)!!! 1) What should be done after ECG with ST elevation in the setting of possible AORTIC DISSECTION? 1) ANATOMIC CT ANGIOGRAM!!! MICELLANEOUS 1) Which is the FIRST BRANCH of the SUBCLAVIAN ARTERY? - THE INTERNAL THORACIC ARTERY!!! 2) What does it supply? - ANTERIOR CHEST WALL AND BREASTS!!! (Branches: thymus, mediastinum, sternum) 3) It bifurcates in the SIXTH INTERCOSTAL SPACE TO: - MUSCULOPHRENIC AND SUPERIOR EPIGASTRIC ARTERIES!!! 4) Where is the ABSORPTION OF B12 AND BILE GIVEN? - IN THE TERMINAL ILEUM!!! 5) What does DUODENUM ABSORB? - ADEK (SECONDARY) + Ca + iron + phosphorus 6) And JEJUNUM? - MAIN!!! ADEK & MINERALS!!! 7) Which is the most common intestinal part affected by CHRON? - TERMINAL ILEUM!!! 8) Which ANTIHYPERTTENSIVES should be dc before sx? - ACEI’S VASCULAR 1) Which is the area of bowel distribution of the SMA? 2) 3) 4) - Proximal jejunum to distal TRANSVERSE colon Which areas of the SMA are affected by an emboli? ILEOCOLIC ARTERY -> MID JEJUNUM AND ASCENDING COLON!!! Which is the tx for new-onset CLAUDICATION? SMOKING CESSATION, STATIN, ASPIRIN When is CILOSTAZOL CONTRAINDICATED? HEART FAILURE!!! HEMATOLOGY 1) Which is the most common associated infection in blood products? - BACTERIAL INFECTION PLASTIC SURGERY 1) Which are the 3 phases of SKIN GRAFT HEALING? - IMBIBITION (1), INOSCULATION (2), AND REVASCULARIZATION!!! GENERAL SURGERY 1) Which is the best tx for INTRAABDOMINAL infex px in penicillin allergic pxs? - METRONIDAZOLE (OR CLINDA) & AMINOGLYCOSIDE 2) Which inguinal hernia is LATERAL to INFERIOR EPIGASTRIC ARTERY? - INDIRECT ONE 3) Which is its cause? - PATENT PROCESSUS VAGINALIS!!! 4) Which is the cause of DIRECT INGUINAL HERNIA? - COJOINT TENDON WEAKNES!! COLORECTAL SURGERY 1) Which is the best tx for CHRONIC ANAL FISTULAS (resistant to nonoperative tx)? - LATERAL INTERNAL SPHINCTEROTOMY!!! 2) And if they have HYPOTONIC ANAL SPHINCTER (obstetric trauma or previous anal sx)? - FISSURECTOMY WITH ANOCUTANEOUS ADVANCEMENT FLAP TRAUMA 1) Which is the best tx for TRACHEAL INJURY? - REPAIR WITH 1 LAYER OF ABSORBABLE SUTURE + BUTTRESS WITH STRAP MUSCLE!! 2) Which are the 6 MOTOR from GCS? 6: F COMMANDS, 5: LOCALIZES PAIN, 4: WITHDRAWS, 3: DECORTICATE, 2: DECEREBRATE, 1: NONE 3) Which are the 5 VERBAL from GCS? 5: NORMAL CONVERSATION, 4: DISORIENTED, 3: NONCOHERENT, 2: GROANS/MOANS, 1: NONE 4) Which are the 4 EYE from GCS? 4: SPONTANEOUS, 3: TO VOICE, 2: TO PAIN, 1: NONE 5) For how long should you give PPX ABX for a blunt/penetrating intraabdominal trauma? - 12 TO 24 HOURS!!! SICU 1) Which ELECTROLYTE DISTURBANCES ARE SEEN BY HYPOMAGNESEMIA by DIARRHEA? - REFRACTORY HYPOKALEMIA AND HYPOCALCEMIA 2) From TEG, what does R mean and how you treat it? - COAGULATION FACTORS (time to form a clot) -> TX FFP!!! 3) And K-time and alpha curve? - CLOT FIXED STRENGHT, AND FIBRIN ACCUMULATION -> TX CRYOPRECIPITATE!! 4) And MAX AMPLITUD? - PLATELETS AND DESMOPRESSIN 5) AND LYSIS AT 30 MINS? - EXCESS OF FIBRINOLYSIS -> TX: TRANEXEMIC AC OR AMINOCAPROIC ACID!!! BREAST 1) Which is the tx for PAGET ? - RADICAL MASTECTOMY + SNL ONCOLOGY 1) What should be done PRIOR to FORMAL ONCOLOGIC RESECTION OF PANCREATIC CANCER? - DIAGNOSTIC LAPAROSCOPY! 2) Which is the tx of LOW GRADE MALT LYMPHOMA BY HELICOBACTER PYLORI? - ANTIBIOTICS: CLARYTHROMYCIN AND AMOXICILLIN 3) And for HIGH GRADE MALT LYMPHOMA? - RADIATION AND CHEMOTHERAPY MISC 1) Which is the mech of action of SILVER? - RIBOSOMAL TOX, INTERCALATES IN DNA!!!, DISRUPTS BACT CELL MEMBRANE, DENATURATION OF PROTEINS!!! CARDIOTHORACIC 1) Which is the management of UNCOMPLICATED TYPE B AORTIC DISSECTION? - IV B-BLOCKERS (ESMOLOL DRIP) NEW 1) 2) 3) Which are the 2 classic findings of PERITONITIS SECONDARY TO PERITONEAL DIALYSIS? CLOUDY PERITONEAL DIALYSATE ABD PAIN SYSTEMIC SXS How do you diagnose it? PERITONEAL FLUID ANALYSIS!!! Which is the tx for an abdominal RECTUS SHEATH HEMATOMA? 4) 5) STABLE: CTA THEN ANGIOEMBOLIZATION UNSTABLE: SX INTERVENTION Which is the main characteristic of a PEDIATRIC MESENTERIC CYST? FREE MOBILE AND PERPENDICULARLY TO THE ATTACHMENT OF THE MESENTERY Which is the management if VENTRAL HERNIA if found when trying to put a pERITONEAL DIALYSIS CATHETER? - HERNIA REPAIR WITH EXTRAPERITONEAL PROSTHETIC MESH AND PLACEMENT OF PDC 6) Which is the tx for endometriosis found in laparoscopy? LASER (THERMAL) ABRASION or EXCISION 7) Which is the tx for TYPE 3 ABDOMINAL RECTUS SHEATH HEMATOMAS (hematoma between transversalis fascia and muscle in the peritoneum and in the prevesical space)!!!? - ANGIOEMBOLIZATION OF INGERIOR EPIGASTRIC ARTERY