Yield and Frequently Missed ABSITE
questions with correct answers
90% of bile is reabsorbed daily. Through which circulation and what means? -
Enterohepatic circulation
Active resorption: of conjugated bile in terminal ileum (45%)
Passive resorption of non-conjugated bile in SB (40%)/colon (5%)
Abnormal fallopian tube at appendectomy - what do? - appendectomy, leave tube alone
acid-base disturbance seen in treatment with sulfamylon (mafenide sodium) -
hyperchloremic metabolic acidosis due to carbonic anhdrase inhibition, leads to
decreased renal conversion of bicarb to water and Co2, ultimately leading to
alkalinization of urine
Action of prostacyclin A2 - inhibitor of platelet aggregation
adverse post op effect of colchicine - inhibits wound contraction
adverse reaction seen in treatment of burns with silvadene - neutropenia and
thrombocytopenia
anatomy of the foramen of winslow - portal triad anterior (portal vein posterior, CBD
lateral, hepatic artery medial), IVC posterior, duodenum inferior, liver superior
Avoid cervical sympathectomy in pts with? - scleroderma
Best way to Dx SB injury in awake trauma pt - serial exams
Best way to predict risk of bleeding - H&P
Biliary: lap chole injury to CBD - what characterizes minor injury and what is treatment?
- recognized intra-op, repair primarily +/- stent
Biliary: what is needed normally for major CBD injury, and what is not needed? - need
RNY hepaticojejunostomy, not hepatico or choledochoduodenostomy (never feasible)
Biliary: what is treatment for gallbladder CA based on presentation (2 major options)? -
If T1a (confined only to lamina propria) cholecystecotmy; anything else, then
,skeletonize area, plus wedge segment 4/5 liver and regional nodes, consider CBD if
cystic duct involved
Biliary: what is treatment for types of choledochal cyst (1-5)? - all need resection with
CCY / CBD removal, RNY hepaticojejunostomy, 4+5 need hepatectomy vs. transplant if
diffuse
Boundaries of femoral hernias - cooper's ligament, inguinal ligament, femoral vein.
hernia passes under inguinal ligament, bulge in anteromedial thigh, reduce through
inguinal ligament division, repair with McVay or Bassini repair.
Breast: for atypical ductal hyperplasia; atypical lobular hyperplasia; LCIS, how are these
characterized and what treatment should be considered? - benign proliferative dz. Incr
risk of CA.
Need to resect - don't need (-) margins
Can give hormone therapy
- pre-meno: tamoxifen
- post-meno: raloxifene
Bilateral total mastectomy (no ALND)
Breast: LCIS -- what % have synchronous cancer? - 5%
Breast: LCIS -- what is treatment (4 possibility, 2 things not needed ever)? - 1) Need to
resect the lesion but do not need neg margins
2) nothing and careful F/U
3) Hormonal therapy
-(pre-meno: tamoxifen; Post-meno: raloxifene)
4) bilateral subcutaneous mastectomy (no ALND)
Breast: LCIS -- who primarily gets this, what is most important characteristic, what %
get cancer, where, and what type? - - pre-menopausal
- NOT premalignant itself
- 30% lifetime risk
70% ductal CA
Breast: what are 3 chemo agents used for breast CA typically? - 1) adriamycin; 2)
cyclophosphamide; 3) taxol
Breast: What are contraindications to BCT (lumpectomy) in stage I breast cancer (and
what specifically is not)? - 1) prior irradiation;
2) pos margins;
3) inflammatory;
4) pregnancy (unless 3rd trimester)
Breast: what are the axillary node levels (1-3, and one more category)? - 1 - lateral to
pec minor;
, 2 - beneath pec minor;
3 - medial to pec minor;
Rotter's Nodes - between pec major and pec minor
Breast: What are the benign proliferative breast lesions that have increased risk of CA?
(3)
Tx? - - LCIS
- Atypical ductal hyperplasia
- atypical lobular hyperplasia
Tx: resect the lesion w/ (-) margins
Breast: what do you do if you can't find radiotracer dye in SNLB? - have to do formal
ALND
Breast: what is main SE of adriamycin (doxorubacin)? - cardiomyopathy
Breast: what is main SE of taxol? - taxol - neuropathy
Breast: what is not needed for patient with negative SLNB? - ALND -- just do BCT or
mastectomy depending on tumor is fine
Breast: What is presentation, treatment, prognosis for intraductal papilloma? - presents
with bleeding/bloody nipple discharge (most common cause), usually benign,
biopsy/resect via major duct excision
Breast: what is treatment for DCIS in male/female? - female -- BCT + xrt OR
mastectomy; male -- mastectomy
Breast: what is treatment for inflammatory breast cancer (in order)? - neoadjuvant
chemo, then mastectomy (mod radical), then XRT
Breast: what options are available for breast mass post neoadjuvant therapy? - same as
de novo breast cancer -- BCT or mastectomy -- if tumor shrunk and now amenable to
BCT, that's fine, even if it was big before and needed mastectomy based on size
Breast: what patient would get mastectomy/BCT + chemo (no tamoxifen)? - negative
SLN, ER-
Breast: what patient would get mastectomy/BCT + tamoxifen for 5 years plus chemo (4
characteristics)? - negative SLN, young, ER+, and tumor >1cm
Breast: what patient would get only mastectomy/BCT + tamoxifen for 5 years (4
characteristics)? - negative SLN, old, ER+, and tumor <2 cm
Breast: when is SNLB indicated (size, nodes, tumor status, metastatic risk)>? - >1 cm,
no positive nodes (obviously), primary tumor present, low risk of axillary mets,
questions with correct answers
90% of bile is reabsorbed daily. Through which circulation and what means? -
Enterohepatic circulation
Active resorption: of conjugated bile in terminal ileum (45%)
Passive resorption of non-conjugated bile in SB (40%)/colon (5%)
Abnormal fallopian tube at appendectomy - what do? - appendectomy, leave tube alone
acid-base disturbance seen in treatment with sulfamylon (mafenide sodium) -
hyperchloremic metabolic acidosis due to carbonic anhdrase inhibition, leads to
decreased renal conversion of bicarb to water and Co2, ultimately leading to
alkalinization of urine
Action of prostacyclin A2 - inhibitor of platelet aggregation
adverse post op effect of colchicine - inhibits wound contraction
adverse reaction seen in treatment of burns with silvadene - neutropenia and
thrombocytopenia
anatomy of the foramen of winslow - portal triad anterior (portal vein posterior, CBD
lateral, hepatic artery medial), IVC posterior, duodenum inferior, liver superior
Avoid cervical sympathectomy in pts with? - scleroderma
Best way to Dx SB injury in awake trauma pt - serial exams
Best way to predict risk of bleeding - H&P
Biliary: lap chole injury to CBD - what characterizes minor injury and what is treatment?
- recognized intra-op, repair primarily +/- stent
Biliary: what is needed normally for major CBD injury, and what is not needed? - need
RNY hepaticojejunostomy, not hepatico or choledochoduodenostomy (never feasible)
Biliary: what is treatment for gallbladder CA based on presentation (2 major options)? -
If T1a (confined only to lamina propria) cholecystecotmy; anything else, then
,skeletonize area, plus wedge segment 4/5 liver and regional nodes, consider CBD if
cystic duct involved
Biliary: what is treatment for types of choledochal cyst (1-5)? - all need resection with
CCY / CBD removal, RNY hepaticojejunostomy, 4+5 need hepatectomy vs. transplant if
diffuse
Boundaries of femoral hernias - cooper's ligament, inguinal ligament, femoral vein.
hernia passes under inguinal ligament, bulge in anteromedial thigh, reduce through
inguinal ligament division, repair with McVay or Bassini repair.
Breast: for atypical ductal hyperplasia; atypical lobular hyperplasia; LCIS, how are these
characterized and what treatment should be considered? - benign proliferative dz. Incr
risk of CA.
Need to resect - don't need (-) margins
Can give hormone therapy
- pre-meno: tamoxifen
- post-meno: raloxifene
Bilateral total mastectomy (no ALND)
Breast: LCIS -- what % have synchronous cancer? - 5%
Breast: LCIS -- what is treatment (4 possibility, 2 things not needed ever)? - 1) Need to
resect the lesion but do not need neg margins
2) nothing and careful F/U
3) Hormonal therapy
-(pre-meno: tamoxifen; Post-meno: raloxifene)
4) bilateral subcutaneous mastectomy (no ALND)
Breast: LCIS -- who primarily gets this, what is most important characteristic, what %
get cancer, where, and what type? - - pre-menopausal
- NOT premalignant itself
- 30% lifetime risk
70% ductal CA
Breast: what are 3 chemo agents used for breast CA typically? - 1) adriamycin; 2)
cyclophosphamide; 3) taxol
Breast: What are contraindications to BCT (lumpectomy) in stage I breast cancer (and
what specifically is not)? - 1) prior irradiation;
2) pos margins;
3) inflammatory;
4) pregnancy (unless 3rd trimester)
Breast: what are the axillary node levels (1-3, and one more category)? - 1 - lateral to
pec minor;
, 2 - beneath pec minor;
3 - medial to pec minor;
Rotter's Nodes - between pec major and pec minor
Breast: What are the benign proliferative breast lesions that have increased risk of CA?
(3)
Tx? - - LCIS
- Atypical ductal hyperplasia
- atypical lobular hyperplasia
Tx: resect the lesion w/ (-) margins
Breast: what do you do if you can't find radiotracer dye in SNLB? - have to do formal
ALND
Breast: what is main SE of adriamycin (doxorubacin)? - cardiomyopathy
Breast: what is main SE of taxol? - taxol - neuropathy
Breast: what is not needed for patient with negative SLNB? - ALND -- just do BCT or
mastectomy depending on tumor is fine
Breast: What is presentation, treatment, prognosis for intraductal papilloma? - presents
with bleeding/bloody nipple discharge (most common cause), usually benign,
biopsy/resect via major duct excision
Breast: what is treatment for DCIS in male/female? - female -- BCT + xrt OR
mastectomy; male -- mastectomy
Breast: what is treatment for inflammatory breast cancer (in order)? - neoadjuvant
chemo, then mastectomy (mod radical), then XRT
Breast: what options are available for breast mass post neoadjuvant therapy? - same as
de novo breast cancer -- BCT or mastectomy -- if tumor shrunk and now amenable to
BCT, that's fine, even if it was big before and needed mastectomy based on size
Breast: what patient would get mastectomy/BCT + chemo (no tamoxifen)? - negative
SLN, ER-
Breast: what patient would get mastectomy/BCT + tamoxifen for 5 years plus chemo (4
characteristics)? - negative SLN, young, ER+, and tumor >1cm
Breast: what patient would get only mastectomy/BCT + tamoxifen for 5 years (4
characteristics)? - negative SLN, old, ER+, and tumor <2 cm
Breast: when is SNLB indicated (size, nodes, tumor status, metastatic risk)>? - >1 cm,
no positive nodes (obviously), primary tumor present, low risk of axillary mets,
