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A 32yr old unrestrained driver in has gross hematuria. His
workup reveals a fracture of the superior & inferior pelvic rami
on the right and a bladder injury is suspected. Which of the
following is NOT true regarding traumatic bladder injuries?
a.) the majority of bladder injuries are extraperitoneal
b.) retrograde CT cystography has a high sensitivity and
specificity for bladder injury in blunt trauma
c.) extraperitoneal bladder injuries can be treated with urinary
catheter drainage
d.) if a patient undergoes laparotomy for another abdominal
injury, extraperitoneal bladder injuries should be repaired in the
stable patient
e.) Most intraperitoneal bladder perforations occur in the
trigone - ANSWER -(e)
What are increased levels of calcitonin from parafollicular cells
(C cells) derived
from?
,a.) Thyroid (follicular ca)
b.) Thyroid (papillary ca)
c.) Thyroid (medullary ca)
d.) Thyroid (anaplastic ca)
e.) Parathyroid - ANSWER -(c)
neural crest cells (they make calcitonin)
The coronary artery bypass graft conduit with the highest
patency after 5 and 10
years
is:
a.) left internal thoracic artery
b.) right internal thoracic artery
c.) left radial artery
d.) right radial artery
e.) left or right long saphenous vein - ANSWER -(a)
What is the mechanism of action of propylthiouracil?
a.) inhibits reduction & coupling of iodine
b.) inhibits oxidation, coupling, and decreases conversion of T4
→ T3
c.) decrease the formation of stored thyroid hormone
d.) none of the above - ANSWER -(b)
PTU inhibits the enzyme thyroperoxidase, which normally acts
in thyroid hormone synthesis by oxidizing the anion iodide (I-)
,to iodine (I0), facilitating iodine's addition to tyrosine residues
on the hormone precursor thyroglobulin. This is one of the
essential steps in the formation of thyroxine (T4). It also
decreases conversion of T4 → T3
Methylthiouracil: blocks pump, inhibits oxidation and coupling
The most important effect of Lugol's iodine administration
prior to thyroid
surgery
is
a.) a reduced incidence of thyroid storm
b.) a reduced incidence of vocal cord palsy
c.) an increased chance of preservation of the parathyroid
glands
d.) increased pigmentation to assist in gland identification
e.) reduced vascularity of the gland - ANSWER -(a)
The Wolff-Chaikoff effect is a reduction in thyroid hormone
levels caused by
ingestion of a large amount of iodine. The high I-doses inhibit
TSH, useful in
thyroid
storm
A 46yr old has a palpable neck mass. FNA reveals papillary
cells. At neck exploration, she has a 4cm tall cell variant
papillary cancer with no lymphatic invasion, but with
lymphocytic thyroiditis. Total thyroidectomy is performed.
, Which of the following gives her a more unfavorable
prognosis?
A.
gender
B.
age
C. primary tumor
size
D. tall cell
variant
E. lymphocytic thyroiditis -
ANSWER -(d)
Papillary Thyroid CA:
a.) It comprises 85% of all thyroid cancer
b.) 80% of kids and 20% of adults present with a palpable lymph
node
c.) It metastasizes to lungs or bones
d.) It's growth rate is stimulated by TSH
e.) All of the above - ANSWER -(e)
Most common (85%, P for Popular), Lymphatic spread but
nodes don't predict survival. 20% of adults, 80% of children
present node positive. Psammoma bodies on path,
represents deposited calcium. Hx of exposure to radiation ↑
risk.