白袍Clarkの知識充電站

1. Clinical determinants of brain death are the loss of the papillary,
corneal, oculovestibular, oculocephalic, oropharyngeal, and respiratory
reflexes for > 6 hours. The patient should also undergo an apnea test, in
which the pCO2 is allowed to rise to at least 60 mmHg without coexistent
hypoxia. The patient should be observed for the absence of spontaneous
breathing.

2. The estimated risks of HBV, HCV, and HIV transmission by blood transfusion
in the United States are 1 in 205,000 for HBV, 1 in 1,935,000 for HCV, and 1
in 2,135,000 for HIV.

3. The most common location of an undescended testis is the inguinal canal.

4. The most common solid renal mass in infancy is a congenital mesoblastic
nephroma and in childhood a Wilms' tumor.

5. Ogilvie's syndrome is acute massive dilatation of the cecum and the
ascending and transverse colon without organic obstruction.

6. The best screening method for prostate cancer is digital rectal exam
combined with serum prostate-specific antigen.

7. The most common histologic type of bladder cancer is transitional cell
carcinoma.

8. Carcinoma in situ of the bladder is treated with immunotherapy with
intravesical bacillus Calmette-Gurin (BCG).LOLZ.. BCG used for Ca?

9. Localized renal cell carcinoma is treated with surgery (radical
nephrectomy).

10.The most common cause of male infertility is varicocele.

11. The most common nonbacterial cause of pneumonia in transplant patients is
cytomegalovirus.

12. Chimerism is leukocyte sharing between the graft and the recipient so
that the graft becomes a genetic composite of both the donor and the
recipient.

13. OKT3 is a mouse monoclonal antibody that binds to and blocks the T-cell
CD3 receptor.

14. The most common disease requiring liver transplant is hepatitis C.
                                                         (Hep B in TW)
15. Cystic hygroma is a congenital malformation with a predilection for the
neck. It is a benign lesion that usually presents as a soft mass in the
lateral neck.

16. In neuroblastomas, age at presentation is the major prognostic factor.
Children younger than 1 year have an overall survival rate > 70%, whereas the
survival rate for children older than 1 year is < 35%.

17. The most feared complication of diaphragmatic hernia is persistent fetal
circulation.

18. The three most common variants of tracheoesophageal fistula are (1)
proximal esophageal atresia with distal tracheoesophageal fistula, (2)
isolated esophageal atresia, and (3) tracheo-esophageal fistula with
esophageal atresia.

19. Atresia can occur anywhere in the GI tract: duodenal (50%), jejunoileal
(45%), or colonic (5%). Duodenal atresia arises from failure of
recanalization during the 8th-10th week of gestation; jejunoileal and colonic
atresia are caused by an in utero mesenteric vascular accident.

20. The types of aortic dissection are ascending (type A) dissection, which
involves only the ascending or both the ascending and descending aorta, and
descending dissection (type B), which involves only the descending aorta.

21. A solitary pulmonary nodule is < 3 cm and is discrete on chest
radiograph. It is usually surrounded by lung parenchyma.

22. Mediastinal staging is indicated in patients with apparent or documented
lung cancer who have (1) known lung cancer with mediastinal nodes > 1 cm
accessible by cervical mediastinal exploration, as assessed by CT scan; (2)
adenocarcinoma of the lung and multiple mediastinal lymph nodes < 1 cm; (3)
central or large (> 5 cm) lung cancers with mediastinal lymph nodes < 1 cm;
and (4) lung cancer with risk of thoracotomy and lung resection.

23. The most common causes of aortic stenosis are now congenital anomalies
and calcific (degenerative) disease.

24. In mitral regurgitation, the left ventricle ejects blood via two routes:
(1) antegrade, through the aortic valve, or (2) retrograde, through the
mitral valve. The amount of each stroke volume ejected retrograde into the
left atrium is the regurgitant fraction. To compensate for the regurgitant
fraction, the left ventricle must increase its total stroke volume. This
ultimately produces volume overload of the left ventricle and leads to
ventricular dysfunction.

25. The indications for CABG are (1) left main coronary artery stenosis; (2)
three-vessel coronary artery disease (70% stenosis) with depressed left
ventricular (LV) function or two-vessel coronary artery disease (CAD) with
proximal left anterior descending (LAD) involvement; and (3) angina despite
aggressive medical therapy.

26. Hibernating myocardium is improved by CABG. Myocardial hibernation refers
to the reversible myocardial contractile function associated with a decrease
in coronary flow in the setting of preserved myocardial viability. Some
patients with global systolic dysfunction exhibit dramatic improvement in
myocardial contractility after CABG.

27. The surgical treatment of ulcerative colitis is total colectomy with
ileoanal pouch anastomosis.

28. Dieulafoy's ulcer is a gastric vascular malformation with an exposed
submucosal artery, usually within 2-5 cm of the gastroesophageal junction. It
presents with painless hematemesis, often massive.

29. The role of blind subtotal colectomy in the management of massive lower
gastrointestinal bleeding is limited to a small group of patients in whom a
specific bleeding source cannot be identified. The procedure is associated
with a 16% mortality rate.

30. Colorectal polyps < 2 cm have a 2% risk of containing cancer, 2 cm polyps
have a 10% risk, and polyps > 2 cm have a cancer risk of 40%. Sixty percent
of villous polyps are > 2 cm, and 77% of tubular polyps are < 1 cm at the
time of discovery.

31. Patients with colorectal cancer with lymph node involvement (Dukes' C)
should receive chemotherapy postoperatively to treat micrometastases.

32. Goodsall's rule states the location of the internal opening of an
anorectal fistula is based on the position of the external opening. An
external opening posterior to a line drawn transversely across the perineum
originates from an internal opening in the posterior midline. An external
opening, anterior to this line, originates from the nearest anal crypt in a
radial direction.
Incarcerated inguinal hernia: structures in the hernia sac still have a good
blood supply but are stuck in the sac because of adhesions or a narrow neck
of the hernia sac. Strangulated inguinal hernia: hernia structures have a
compromised blood supply because of anatomic constriction at the neck of the
hernia.

33. Incarcerated inguinal hernia: structures in the hernia sac still have a
good blood supply but are stuck in the sac because of adhesions or a narrow
neck of the hernia sac. Strangulated inguinal hernia: hernia structures have
a compromised blood supply because of anatomic constriction at the neck of
the hernia.

34. Chvostek's sign is spasm of the facial muscles caused by tapping the
facial nerve trunk. Trousseau's sign is carpal spasm elicited by occlusion of
the brachial artery for 3 minutes with a blood pressure cuff.

35. The two surgical options for Graves' disease are subtotal thyroidectomy
or near-total thyroidectomy.

36. The only biochemical test that is routinely needed to identify patients
with unsuspected hyperthyroidism is serum thyroid-stimulating hormone
concentration.

37. The surgically correctable causes of hypertension are renovascular
hypertension, pheochromocytoma, Cushing's syndrome, primary
hyperaldosteronism, coarctation of the aorta, and unilateral renal
parenchymal disease.

38. The "triple negative test" or "diagnostic triad" for diagnosing a
palpable breast mass includes physical examination, breast imaging, and
biopsy.

39. Chest wall radiation is indicated after mastectomy in patients with
greater than 5 cm primary cancers, positive mastectomy margins, or more than
four positive lymph nodes, all of which are associated with heightened
locoregional recurrence rates.

40. Sentinel lymph nodes are the first stop for tumor cells metastasizing
through lymphatics from the primary tumor.

41. The most common site of origin of subungual melanomas is the great toe.
Amputation at or proximal to the metatarsal phalangeal joint and regional
sentinel lymph node biopsy are advised by most authors.

42. Ramus marginalis mandibularis, the lowest branch of the nerve that
innervates the depressor muscles of the lower lip, is the most commonly
injured facial nerve branch during parotidectomy.

43. Waldeyer's ring is the mucosa of the posterior oropharynx covering a bed
of lymphatic tissue that aggregates to form the palatine, lingual,
pharyngeal, and tubal tonsils. These structures form a ring around the
pharyngeal wall. This may be the site of primary or metastatic tumor.

44. A patient in whom the head and neck examination is completely normal but
FNA of a cervical node reveals squamous cancer should have examination of the
mouth, pharynx, larynx, esophagus, and tracheobronchial tree under anesthesia
(triple endoscopy). If nothing is seen, blind biopsy of the nasopharynx,
tonsils, base of tongue, and pyriform sinuses should be done at the same
sitting.

45. The microorganisms implicated in atherosclerosis include Chlamydia
pneumoniae, Helicobacter pylori, streptococci, and Bacillus typhosus.

46. The cumulative 10-year amputation rate for claudication is 10%.

47. The absolute reduction in risk of stroke is 6% over a 5-year period in
asymptomatic patients with > 60% stenosis who undergo carotid endarterectomy
plus aspirin versus patients treated with aspirin alone (5.1% versus 11%).

48. Abdominal aortic aneurysm's average expansion rate is 0.4 cm/year.

49. Heparin binds to antithrombin III, rendering it more active.

50. The patient with suspected intermittent claudication should initially be
evaluated by obtaining ankle brachial index or segmental limb pressures at
rest.

51. Shock is suboptimal consumption of O2 and excretion of CO2 at the
cellular level.

52. Nitric oxide is synthesized in vascular endothelial cells by constitutive
nitric oxide synthase and inducible NOS, using arginine as the substrate.

53. Saliva has the hightest potassium concentration (20 mEq), followed by
gastric secretions (10 mEq), then pancreatic and duodenal secretions (5 mEq).

54. Basal caloric expenditure = 25 kcal/kg/day with a requirement of
approximately 1 g protein/kg/day.

55. 6.25 g of protein contains 1 g of nitrogen.

56. Dextrose has 3.4 kcal/g, protein 4 kcal/g, fat 9 kcal/g (20% lipid
solution delivers 2 kcal/mL).

57. Maximal glucose infusion rates in parenteral formulas should not exceed 5
mg/kg/min.

58. Refeeding syndrome occurs in moderately to severely malnourished patients
(e.g., chronic alcoholism or anorexia nervosa) who, upon presentation with a
large nutrient load, develop clinically significant decreases in serum
phosphorus, potassium, calcium, and magnesium levels. Hyperglycemia is common
secondary to blunted insulin secretion. ATP production is mitigated, and the
classic presentation is respiratory failure.

59. Glutamine is the most common amino acid found in muscle and plasma.
Levels decrease after surgery and physiologic stress. Glutamine serves as a
substrate for rapidly replicating cells (interestingly, it is also the number
one metabolic substrate for neoplastic cells), maintains the integrity and
function of the intestinal barrier, and protects against free radical damage
by maintaing GSH levels. Glutamine is unstable in IV form unless linked as a
dipeptide.

60. Fever is caused by activated macrophages that release interleukin-1,
tumor necrosis factor, and interferon in response to bacteria and endotoxin.
The result is a resetting of the hypothalamic thermoregulatory center.

61. Cardiac output = heart rate x stroke volume; normal CO is 5-6 L/min.

62. SVR = [(MAP - CVP)/CO] x 80; normal SVR is 800-1200 dyne.sec/cm-5.

63. Hypovolemic shock: low CVP and PCWP, low CO and SVO2, high SVR.

64. Cardiogenic shock: high CVP and PCWP, low CO and SVO2, variable SVR.

65. Septic shock: low or normal CVP and PCWP, high CO initially, high SVO2,
low SVR.

66. Kehr's sign is concurrent LUQ and left shoulder pain, indicating
diaphragmatic irritation from a ruptured spleen or subdiaphragmatic abscess.
Anatomically, the diaphragm and the back of the left shoulder enjoy parallel
innervation.

67. Rebound tenderness implies peritoneal inflammation and irritation not
simply abdominal tenderness.

68. The 5 Ws of post-operative fever are wound (infection), water (UTI), wind
(atelectasis, pneumonia), walking (thrombophlebitis), and wonder drugs (drug
fevers).

69. Cricothyroidotomy should not be performed in patients <> 80 mmHg; femoral
(groin) pulse estimates SBP > 70 mmHg; and carotid (neck) pulse estimates SBP
> 60 mmHg.

71. A general rule for crystalloid infusion to replace blood loss is a 3:1
ratio of isotonic crystalloid to blood.

72. Raccoon eyes (periorbital ecchymosis) and Battle's sign (mastoid
ecchymosis) are clinical indicators of basilar skull fracture.

73. CPP = MAP - ICP. Some debate exists on the minimum allowable CPP, but
consensus indicates that a cerebral perfusion pressure of 50-70 mmHg is
necessary.

74. Violation of the platysma defines a penetrating neck wound.

75. Tension pneumothorax is air accumulation in the pleural space eliciting
increased intrathoracic pressure and resulting in a kinking of the SVC and
IVC that compromises venous return to heart.

76. The most common site of thoracic aortic injury in blunt trauma is just
distal to the take-off of the left subclavian artery.

77. The most common manifestation of blunt myocardial injury is arrhythmia.

78. Indications for thoracotomy in a stable patient with hemothorax include
an immediate tube thoracostomy output of > 1500 mL and ongoing bleeding of
250 mL/h for 4 consective hours.
79. Beck's triad is hypotension, distended neck veins, and muffled heart
sounds.

80. The hepatic artery supplies approximately 30% of blood flow to the liver
while the portal vein supplies the remaining 70%. The oxygen delivery,
however, is similar for both at 50%.

81. The Pringle maneuver is a manual occlusion of the hepatoduodenal ligament
to interrupt blood flow to the liver.

82. Splenectomy significantly decreases IgM levels.

83. 90% of trauma fatalities due to pelvic fractures are due to venous
bleeding and bone oozing; only 10% of fatal pelvic bleeding from blunt trauma
is arterial (most common site is superior gluteal artery).

84. Intraperitoneal bladder rupture from blunt trauma: operative management;
extraperitoneal rupture: observant management.

85. Pseudoaneurysm is a disruption of the arterial wall leading to a
pulsatile hematoma contained by fibrous connective tissue (but not all three
arterial wall layers, which defines a true aneurysm).

86. The earliest sign of lower extremity compartment syndrome is neurologic
in the distribution of the peroneal nerve with numbness in the first dorsal
webspace and weak dorsiflexion.

87. Posterior knee dislocations are associated with popliteal artery injuries
and are an indication for angiography.

88. Management of suspected navicular fracture despite negative radiography
is short-arm cast and repeat x-ray in 2 weeks; at high risk for avascular
necrosis.

89. Parkland formula: lactated Ringer's at 4 mL/kg x %TBSA (second- and
third-degree only) of burn. Infuse 50% of volume in first 8 hours and the
remaining 50% over the subsequent 16 hours.

90. The metabolic rate peaks at 2.5 times the basal metabolic rate in severe
burns > 50% TBSA.

91. Gallstones and alcohol abuse are the two main causes of acute
pancreatitis.

92. Alcohol abuse accounts for 75% of cases of chronic pancreatitis.

93. Isolated gastric varices and hypersplenism indicate splenic vein
thrombosis and are an indication for splenectomy.

94. The treatment for gallstone pancreatitis is cholecystectomy and
intraoperative cholangiogram during the same hospital stay once the
pancreatitis has subsided.

95. Proton pump inhibitors irreversibly inhibit the parietal cell hydrogen
ion pump.

96. Definitive treatment of alkaline reflux gastritis after a Billroth II
includes a Roux-en-Y gastro-jejunostomy from a 40-cm efferent jejunal limb.

97. Cushing's ulcer is a stress ulcer found in critically ill patients with
central nervous system injury. It is typically single and deep, with a
tendency to perforate.

98. Curling's ulcer is a stress ulcer found in critically ill patients with
burn injuries.

99. Marginal ulcer is an ulcer found near the margin of gastroenteric
anastomosis, usually on the small bowel side.

100. The most common cause of small bowel obstructions is adhesive disease;
the second most common cause is hernias.