2011 exam Flashcards
Dog bites a child on the hand, what is the treatment?
amox-clav
if face then you need to do closure in layers, if its just on hands you can let it close on its own
patient with renal transplant, presents with fever, back pain and bilateral leg pain. What imaging should you get?
CT, always
what is the MOST specific sign of a aortic dissection on imaging?
widened mediastium
what are 5 signs of ruptured AAA on imagig?
1) widened mediastium over 6 cm
2) apical cap ( blood is where it shouldn’t be in the lung)
3) tracheal deviation to the right ( its usually on the left side of the body)
4) loss of the aortopulmonic window
5) depression of left mainstem bronchus ( because there is blood in the left apical lung cap so everything shifts down)
A domestic cat bites a child on the hand, what abx do you give?
amox clav
How do you treat an extraperitoneal bladder rupture?
foley always, as they are essentially asking about a urethral tear
-there are five types of bladder rupture the most common being extraperitoneal ruptuer ( aka concomitant with a pelvic fracture). Here you place a foley. If there is an intraperitoneal bladder rupture ( eg a full bladder is struck with force) then you need OR repair because the urine leaks into the abdomen.
chronic renal transplant rejection is mediated by?
host lymphocytes
A man has a laceration with gravel and grass in it. What is the most important first step?
irrigation
cyclosporine and tacrolimus mechanism of action is?
suppression of IL2
what this means is that the drug goes into the T cell cytoplasm and blocks the calcineurin pathway, which blocks IL2, which is needed for T cell proliferation
all facts about banked blood are true except
stored blood is ept at pH 6.98
this is false, the blood is stored at about 7.20 on day one and then from there it undergoes glycolysis and lactate acid builds up causing decreased in pH aka it gets acidic
pregnant patient gets a DVT- what SHOULDNT you do?
give her warfarin it causes fetal defects
a postoperative diabetic patient is solmnolent with pH 7.2, Na 145, C02 34.what is the diagnosis?
HHS coma
they are acidotic
Na is high because they are peeing out all their water/ dieuresis
C02
Patient is postoperative from ileal conduit, returns to ED with serosang discharge from upper part of the wound - what should you do?
i cant tell if this is ileum or a urinary coduit. either way, sending some labs seems reasonable, so send the fluid for Cr and Amylase
all true about PE except:
Raised CVP
raised Pc02
raised PCWP
raised PCWP
this is is a false statemetn
Congested pale flap, how do you treat?
leeches
In regards to smoking 8 weeks prior to surgery, all are true EXCEPT?
there seeems to be two answers here, iether decreased pulmonary complications
vs
decreased reactivity of airways
When do you consider thrombectomy for PE
patient has shock/ cardioresp compromise
so the answer is
a)patient with lobar PE and shock
patient has blood at the urethral meatus, what test do you do?
do a retrograde urethrogram by inserting a foley and put in some contrast
child has 25% second and third degree burns what do you do for nutrition?
people are between two answers here, either feeding tube with enteral feeds or central line and TPN right away. I would lean towards the former
What is the treatment for a patient with unstable afib, hr 180, BP soft 70/40
cardioversion
coagulopathy of acute trauma - all true EXCEPT
does not oocur before they reach the trauma bay
OF course they are coagulopathic before hitting the stretcher, we just dont see it in their labs until then
contraindication to TPN is all EXCEPT
starvaton over 7 days
this is actually an indications for TPN
breast cancer patient isnt feeling well, has bone, pain, mets, hypercalcemia. What is the intial treatment?
fluid and lasix
brain death patient is initially stable but suddenly becomes hypotensive, serum sodium is increasing and the urinary outputs at over 500 cc/hr. what is happening and what is the treatment?
diabetes insipidus, likely central
give DDAVP/vasopressin infusion to tell the kidneys to keep water
fat embolism is associated with which?
liposuction
sickle cell
DM
sickle cell - there is a bone marrow ischemia crisis
- however a quick google search also showed embolism after liposuction procedure. I would go with sickle cell tho
woman with worsening peripheral vascular disease, what is the basis of Pouiselles law in determining the resistance in the vessel?
pouseille law says the resistance is inversely proportional to the radius(to the 4th degree) and directly proportional to the length of stenosis
So just remember resistance is inversely proportional to the radius to the 4, directly to length
How does fat appear on the T1 and T2 versions of an MRI?
it is Bright on T2
dark on T1
think of it, the first pass thru, T1 is dark before we hit the light
the definition of the incidence of disease is
the rate of new disease
vs pervalance which is the overall rate of existing disease or absolute amt of disease
C02 in laparoscopic surgery causes all of the following except
increased preload
actually the c02 inflates the diaphragm, pushes on the IVC and casues decreased preload.
There is also hypercarbia that occurs, so you need to ventilate the patient well.
Lastly the trendelenberg
least reactive suture is
polypropolene ( prolene)
what is the most prominent type of collagen in the proliferative phase of wound healing?
collagen III is first placed down starting at 10hrs -24 hrs.
this is then converted to type 1 collagen later in materation
44 year old man 8 yrs post renal transplant, what cancer is he most likely to get?
BCC
testicular
Prostate
non-melanoma skin cancer- BCC!!
Apparently this is very common post solid organ transplant because you are on immunosupressants for so long. makes sense, the skin is a huge organ..
what is the biggest risk for SSI?
Obesity?
Anemia?
thrombocytopenia?
i really dont know
I think anemia since oxygen is so vital and DM patients have such issues with wound healing due to poor oxygenation
patient is in a multitrauma, what are their TPN requirements in terms of
kcal/day
grams of protein/day
% diet that should be lipids
you should give them
30-35kcal/day/kg
1.5-2g prot/day/kg
20-30% lipids
in wound healing what is the correct sequence of events?
injury vasoconstriction vasodilation PMNs/neutrophil invasion re-epithelialize the injury collagen type III deposition contraction of the wound
male on TPN gets septic, and has a non-anion gap metabolic acidosis. What is it from? the lactic acidosis or the TPN?
TPN - it causes a NAGMA when its wrong
recall that lactic acidosis is a cause of anion gap metabolic acidosis (mUDPILES!)
male on TPN gets septic, and has a non-anion gap metabolic acidosis. What is it from? the lactic acidosis or the TPN?
TPN - it causes a NAGMA when its wrong
recall that lactic acidosis is a cause of anion gap metabolic acidosis (mUDPILES!)
treat MRSA osteomyelitis with?
vanco
Example of a clean contaminated wound is:
appy on a non-perforated appendix
In a dirty operation, antibiotics are given, what is the chance of infection?
a book said 5% but thats not an option… so go with `5?? who know
in rhabdo, what happens to phasphate and calcium?
you get hypocalcemia and hyperphosphatemia ( it leaks out of cells)
in pelvic fracture the bleeding comes from
pelvic venous plexus/ posterior plexus
Best was to distinguish between ATN and prerenal cause of low UO is
Fractional excretion of sodium.
in prerenal, the excretion of sodium will be low
in ATN it is high
what are the guidelines for giving peri-op stress steroids?
they need to have been on 20mg IV for 2 weeks prior to surgery..plus there are alot of other rules about this…maybe youll get around to reading them maybe not
in which pathology do you not retain sodium? CHF cirrhosis hypercortisolism hypoaldosteronism
hypoaldo - recall aldo helps you retain NA. without it you pee out your NA, your BP becomes soft and unstable and people collapse. You
Patient post AAA repair, now has lost motor function. What happened?
anterior cord syndrome
