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Pathophysiology of gynecomastia Decreased androgen production and either increased estrogen production or estrogen precursors are the main cause. Also can have decreased androgen to receptor binding and increased androgen binding to sex hormone binding globulin Octreotide mechanism of action for varices treatment Splanchnic vasoconstriction and decreases portal htn Liver abscess treated with flagyl Amoebic liver abscesses from entamoeba histolytica Liver abscess treated with albendazole Hydratid liver cysts Treatment for resectable gallbladder carcinoma Tis and T1a (invasion of lamina propria) chole is sufficient. T1b-T3 chole + 4b/5 hepatectomy, and regional lymphadenectomy pH changes by how much with a change in PaCO2 of 10 mmHg 0.08 Contraindications for ketamine Angina/ischemic heart disease because it increases sympathetic nervous system increasing myocardial O2 consumption. Also contraindicated in space-occupying brain lesions and increased IOP MOA of desmopressin Stimulates endothelial release of factor viii and vWF MOA of propranolol for asymptomatic prophylactic treatment of esophageal varices Non-selective beta blockers inhibit beta2 receptors inhibiting vasodilation is splanchnic circulation, and they decrease cardiac output with beta 1 blockade Pager-schroetter syndrome Exercise induced thrombosis of the subclavian and axillary veins Pathway of beta 2 stimulation GPCR that activates cAMP Receptors that dobutamine Beta1 with low dose and beta2 higher doses 8/30/25, 12:34 PM ABSITE 2021 / 2/20 activates SMA site of occlusion for embolic vs thrombotic etiology and pattern of ischemia Embolic usually distal SMA and causes ischemia from mid-jejunum through transverse colon. Thrombotic is usually proximal SMA and causes ischemia from proximal jejunum through transverse colon. Embolic spares proximal jejunal branches Management of mediastinitis Open debridement and pectoral muscle flaps What do you give for beta blocker overdose? glucagon What is first line treatment for diltiazem overdose? Insulin -- those refractory can be treated with lipid emulsion therapy or transcutaneous pacing Most common organism cultured from septic thrombophlebitis 2/2 contiguous severe pharyngitis or peritonsillar abscess Fusibacterium necrophorum (gram negative rod -- gram negative rods or polymicrobial infections are most common cause of septic thrombophlebitis from secondary, contiguous source Blood supply of the peritoneum Viscera peritoneum is supplied by the splanchnic vessels while the parietal is supplied by the intercostal, lumbar, and iliac vessels UOP desired for adequate resuscitation in adult and pediatric burn pts Adults: 0.5-1 cc/kg, and peds: 1-1.5 cc/kg Most common polypoid lesion of the gallbladder Cholesterolosis = cholesterol laden macrophages in the gallbladder lamina propria, often multiple. Not considered premalignant Premalignant lesions of the gallbladder Adenomas are the only known ones What is bleeding typically in the first 24 hr after hemorrhoidectomy? At 5 days? Technical error, needs to go back to OR for exploration vs 5 day eschar sloughing ROTEM, when do transfuse what? Long clot time: FFP or PCC; MCF (maximal clotting factor = clotting strength) if abnormal analyze FIBTEM and if normal then plts. If FIBTEM abnormal, fibrin problem and give cryo. High lysis index indicates shows need TXA (Inhibits plasmin) 8/30/25, 12:34 PM ABSITE 2021 / 3/20 Essential fatty acids linoleic acid and linolenic acid Inguinal nodes obtained for melanoma Can stop at SLN if not clinically positive and do u/s surveillance q4 mo. But if clinically positive or can't do surveillance: superficial first with superficial inguinal and superficial femoral but if those positive extend to deep femoral, obturator, and iliac nodes Treatment of hyponatremia If severe (120) and acute, treat with bolus of hypertonic saline (3%) with goal to increase by 4-6 mEq in a couple hours. If mild-moderate chronic, then fluid restriction, can also employ fluid restriction if asymptomatic. Alvimopan Mu receptor antagonist Rate of malignancy in main duct IPMN, side duct IPMN, and mucinous cystic neoplasm 60% and 25% for side duct if 3 cm and mural nodules, MCN is 15% but 0% if no mural nodules and 4 cm Which vitamin has been shown to help wound healing in patients on steroids? A Enterochromaffin-like cells secrete what? Histamine Most common location for small bowel lymphoma Ileum Where is the hernia sac most often located in an indirect inguinal hernia? Deep to the cremaster muscle, and anterior and superior to the spermatic cord structures Initial management of severe ulcerative colitis Resuscitation, NG decompression, systemic steroids (either IV methylpred 20 mg q8 or hydrocortisone 100 mg q8), and +/- IV antibiotics (if fulminant colitis, toxic megacolon, peritoneal signs, and/or signs of systemic toxicity). Only operate if perforation, life threatening bleeding, toxic megacolon, fulminant colitis refractory to medical treatment 8/30/25, 12:34 PM ABSITE 2021 / 4/20 Types of choledochal cysts and their treatment 1) Fusiform dilation of the CBD (90%) -- treat with cyst excision and roux-y hepaticojejunostomy; 2) CBD diverticulum -- treat with cyst excision and closure of the choledochotomy; 3) CBD cyst within the duodenal -- transduodenal marsupialization or cyst excision; 4) multiple extrahepatic cyst +/- intrahepatic cysts (b); 5) Caroli's disease Volatile gas anesthetic with the least myocardial depression Nitrous oxide, but doesn't produce enough anesthesia to be used as a single agent. Isoflurane the next best. Adverse effects of halothane Hepatic necrosis and ventricular arrhythmias Non-depolarizing paralytic not metabolized by the liver or kidney Atracurium or its cis isomer cisatracurium -- ester hydrolysis and hoffman elimination Axon regeneration growth rate 1-2 mm/day Treatment of cecal volvulus Right hemicolectomy and ileocolic anastomosis Treatment for acute limb ischemia If Rutherford type IIa or less can attempt catheter directed thrombolysis or if acute thrombosis of chronic disease, but if Rutherford type IIb an embolectomy should be done