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What are the two histologic subtypes of Rhabdomyosarcoma?

1. Embryonal (most common)
2. Alveolar


what are the different types of embryonal rhabdomyosarcoma? (2)

1. Spindle cell- most common in paratesticular lesions
2. Botryoid- polypoid masses that fill the lumen of a hollow viscus (vagina, bladder)


Embyonal rhabdomyosarcoma:
1. young vs old
2. survival?

1. Occurs in younger patients, head and neck region
2. Favorable survival rate 60%


What is roving sign?

right lower quadrant pain induced by palpation in the left lower quadrant (for acute appendicitis)


What is dunphy sign?

increased pain with any coughing or movement and is related to inflammation that involves the parietal peritoneum


what is the obturator sign?

seen with inflammation of the appendix and refers to pain on internal rotation of the right hip


what is the iliopsoas sign?

most often seen with a rhetorical appendix and refers to pain on extension of the right hip


What is immune thrombocytopenia purpura (ITP)?

autoimmune destruction of platelets with clinical manifestations of thrombocytopenia and susceptibility to easy bleeding


What patient population does acute ITP target?



What is chronic ITP?

- accounts for most cases considered for splenectomy
- avg age 40's, women > men


What is the pathophys of ITP?

development of IgG antibody to platelet antigen


First, second and third line treatment of ITP?

1st: high dose steroids
2nd: IVIG
3rd: splenectomy


What 3 things does End tidal CO2 monitoring reflect?

1. Metabolism
2. Circulation
3. Ventilation


In which breast malignancy should patients proceed directly to axillary lymph node dissection?

Inflammatory breast cancer


What non depolarizing muscle relaxant is preferred for endotracheal intubation in patients with either hepatic or renal dysfunction?

Atracurium: (dose 0.3-0.6mg/kg), Hoffman elimination thus good for renal/hepatic impaired ppl, can cause histamine release leading to hypotension


What is Hoffman elimination? i.e. a type of metabolism

spontaneous degradation of drug at physiologic pH


Why is vecuronium the intubation drug of choice in reactive airway patients?

because it doesn't cause histamine release upon administration. (hepatic metabolism, 0.1mg/kg)


What is the longest acting of all muscle relaxants?

doxacurium (max effect at 6 min and duration of action is 83 min)


What is the most common primary lung tumor among infants and children?

Bronchial adenoma- 80% of these are Endobronchial carcinoid


what is the most common benign tumor of the lung in children?

- rare!! but most common is pulmonary hamartoma or chondroma


what stimulates the secretion of aldosterone?

extracellular fluid potassium


when compared with endoscopic sphincterotomy, transduodenal sphincteroplasty is associated with what?

decreased incidence of restenosis


what is a giant condyloma acuminatum? aka Burschke-Lowenstein tumor

- represents verrucous carcinoma
- large cauliflower lesion
- histologically benign but clinically malignant and can invade adjacent organs


Whats one disadvantage of Lactated ringers?

its relatively low sodium content (130 mEq) , hyponatremia can occur with prolonged use


What are the factors that negatively affect post-transplant outcomes?

1. Increased donor age >50
2. Female sex of donor
3. Increased hepatic steatosis of the donor liver
4. Severe donor hypernatremia prior to organ harvest
5. Prolonged cold ischemia time
6. ABO mismatach


most common presentation of branchial anomaly in adolescent is?

cystic mass (arising from the second cleft/pouch)


What are the phases of the cell cycle?

G1, S, G2, M
M: mitosis
S: DNA Synthesis
G1: gap1 separates previous cell division from the beginning of the DNA synthesis, determines length of cycle
G2: short gap phase


a neonate with hypo plastic left heart syndrome depends on what for survival?

patency of the facts arteriosus (facilitated by prostaglandin infusion)


What are 2 treatment options for hypo plastic left heart syndrome?

1. Cardiac transplantation requiring a donor aortic arch
2. Norwood procedure: converts the pulmonary artery into the main outlet for a functional single ventricle


what is an important principle with bypass grafting for aortoiliac occlusive disease?

place the proximal anastomosis as high as possible on the infrarenal aorta