BREAST
56 y/o F presents with a palpable mass. Biopsy proven ILC. She had mammo, US, biopsy. HPI, ROS, fam hx negative. On exam, palp 2cm mobile mass UOQ, LNs neg. Next step
MRI breast
Stage her--CBC, CMP, CXR
I am a medication that can help prevent clot breakdown during bleeding/trauma.
What is TXA, tranexamic acid.
HOB, remove collar, analgesia, sedation, paralytic, manitol, hypertonic saline, hyperventilation, paralytic, pentobarb coma, craniectomy
Parkland formula
for adults
for kids
for electrical burns
2cc/kg x TBSA
3cc/kg x TBSA
4cc/kg x TBSA
Most common anatomical location for a gastrinoma
duodenum--gastrinoma triangle
confluence of the cystic duct and common bile duct
junction of the 2nd/3rd portion of the duo
junction of neck and body of pancreas
True or False. ALL patients with triple negative breast cancer should be offered genetic testing
TRUE
What looking at a TEG, these values mean what?
R, LY30, MA, angle
R: reaction time --> FFP
angle: speed of clot strengthening--> cryo
MA: total clot strength --> platelets, DDAVP
LY30: fibrinolysis --> TXA
Zones of the retroperitoneum
Zones for REBOA
RP Zone I: Mid abd--aorta/IVC
RP Zone II: kidneys
RP Zone III: pelvis
REBOA zone I: intrathoracic aorta
REBOA Zone II: upper abdomen
REBOA zone III: pelvis
70y/o M s/p subtotal colectomy for c diff colitis. He is in the ICU POD #1 oliguric. You give him a fluid bolus and his UOP does not pick up. NICOM not available. What do you want to do to figure out if he needs more fluid?
FeNA: [Una x Pcr] / [Ucr x Pna] x 100
A 44y/o M has neurofibromatosis and a peripancreatic mass. What is the most likely diagnosis?
Somatostatinoma. DM II, cholethiasis, steatorrhea. 90% malignant. 25% in small bowel, sandostatin levels diagnostic. pancreatic head is a common site
ABSOLUTE contraindications to breast conserving therapy requiring XRT
1. XRT during pregnancy
2. Diffuse suspicious or malignant appearing calcifications
3. multicentric disease
4. Diffusely positive pathologic margins
5. Homozygous for ATM
I am the treatment for life-threatening bleeding on Coumadin.
What is Vit K and KCentra?
Name for a left medial visceral rotation
Name for a right medial visceral rotation
Steps
1. Mattox maneuver
2. Cattell Braasch maneuver
equation for cerebral perfusion pressure
CPP = MAP - ICP
48y/o M presents with a rash and a pancreatic mass. What is the most likely diagnosis?
Glucagonomas. present as a red skin patch with a healing center--migratory necrolytic erythema, mild diabetes, cachexia, venous thrombosis. common in the pancreatic tail and can be blindly resected with distal panc if unable to localize.
What is oncotype DX and how is it used?
Gene expression assay
Postmeno: T1b/c-T2, N0, HR+ HER2- <26 no chemo
Postmeno: T1-3, N1, HR+ HER2- <26 no chemo
Premeno: T1b/c-T2, N0, HR+ HER2- <16 no chemo; 16-25 consider chemo; >26 chemo
Premeno: T1-3, N1, HR+, HER2- = all get chemo
You have a patient with Von Willebrand Type I disease with acute appendicitis. You are taking him to the OR. What would you give the patient to help with bleeding?
DDAVP
Best test to rule out a delayed small bowel injury
Let the patient eat
free water deficit equation
[Na now - Na ideal] / Na ideal x kg x 0.6
(0.5 female)
48y/o F with 6 months of watery diarrhea with intermittent flushing and swelling of face and neck. abdominal cramping. lethargic, poor skin turgor, dry mucous membranes. hypokalemia. CT tumor in pancreas. Most likely diagnosis?
VIPoma--watery diarrhea, hypokalemia, achlorhydria syndrome; elevated VIP and calcium; distal pancreas common site; sandostatin can be use for symptomatic relief.
Breast cancer and pregnancy.
1. how do you stage?
2. can they have radiation?
3. can they have chemo?
4. how does surgery differ?
1. CXR (abd shield), US abd, MRI noncon spine
2. NO XRT during pregnangy
3. NO chemo 1st trimester; No HER2 tx at any time during pregnancy
4. No blue dye for sentinel.
Most common inherited coagulation disorder
If you have this deficiency you may need FFP supplementation while on heparin
Factor V Leiden
AT III deficiency
Periduodenal hematoma seen on CT, pt stable
Periduodenal hematoma seen during exploration
1. gastrograffin followed by barium swallow--no leak observe x 2 weeks
2. always explore
Component of the MELD-Na score
1. dialysis
2. creatinine
3. bilirubin
4. INR
5. Sodium
Most common cause of liver abscesses worldwide
amebic--E histolytica