2015 exam Q&A Flashcards
what is the most obvious clinical sign of impending compartment syndrome
pain out of proportion to what is expected and severe pain with stretch of the affected compartment
75 yr male kidney transplant POD 1 unable to extend knee + numbness/pain to anterior thigh. What was injured?
femoral nerve
what does clark 4 level melanoma classification indicate re invasion level
reticular dermis is effected
what is MOA of diabetic foot ulcers?
neuropathy
what antobiotic do you use to treat cat bite?
amox-clav
most common cause of carpal tunnel
tenosynovitis (repeptitive movement gives your tendon strain= tenosynovisit)
what is the most sensitive method to detect Cdiff?
stool test
in what trimester does the fetus receive the most exposure to raditation with xrays?
first is the most vulerable time, but you get the same exposure level no matter when you xray them
patient with perioral tingling after receiving lidocaine. What are the other sns of lido toxicity?
seizure, perioral tingling
a 21 yr old girl has injury causing possible exposure to tetanus. She had all childhood vaccinations and a bootster at age 18. What do you do?
no treatment, she is within the ten year mark
woman in ED, injuries consistent with IPV. 2 children are at home, what do you do?
you cannot report anything as the children are not harmed/you have no evidence. Warn her you are worried for the children, but she is an adult and has to report it.
what are the difference between LMWH and heparin?
we first started with UFH, but we got smarter and made LMWH ( dalt and enoxaparin). these are better than heparin b/c:
1) 99% SC bioavailability more 2) = more predictable anticoagulant
response,
3) less inter-patient variability
4) and longer duration
of action than heparin
how do you reverse heparin?
protamine sulfate
steroid hormones modify cell physiology by binding to regulatory units on DNA. For this to occur the molecule must first be bound by an appropriate receptor. These receptors are located where?
???cytoplasm?
what anesthetic has longest half life and least cardiotoxcitiy?
ropivicaine
other options are procaine, lidocaine, bupivicaine
what is the most sensitive marker of fascial infection
grey dish water appearance - you have nec fasc!!!
how does coag work vs cautery
…..
What causes pulomary vasoconstriction?
low alveolar 02
what medication will decrease the therapeutic effect of warfarin? aka makes it work more
oral contraceptives
peridtric patient comes to the hospital in shock. peripheral IV is not available, what is your next option?
proximal tibia intraosseus line
what describes the correct anatomical position of a saphenous vein cut down?
2cm superior and anterior to the medial malleolus
Th bacille calmette -Guerin vaccine is an exmaple of which type of immunity?
active non specific
which vasopressor is also an inotrope?
epinephrine
you are a plastic surgery trying to do an elective rhinoplasty on a patient who recently had an MI and drug eluting stends put it and is now on plavix. When should you plan to do this surgery?
?delay surgery for ten months then operate…???
what is the first sign of malignant hyperthermia?
increased end tidal CO2 ( ET c02) - this is because the MH makes your muscle cells contract alot, which creates c02
why do we use a c02 colorimeter detector?
to confirm ETT placement in the correct location - aka the lungs
what is the most common cause of esophageal perforation?
esophageal instrumentation
if a patient has AAA, what lifestyle change should you recommend to them as being the best bang for their buck?
smoking cessation-The magnitude of risk with smoking eclipses all other modifiable risk factors for prevalent AAA
what is the most accurate way to diagnose a post op MI
ECG
what is the unmeasured ion that contributes to a non-anion gap metabolic acidosis
albumin, but also phosphate incase you are asked. recall that an anion gap is calculated by POSTIVIES - NEGATIVES =
Na - (Cl+ HCO3)
As you can see albumin isnt in here or phosphate
Hyponatremia causes which of the following?
- Increased urine output(?)
- loss of DTR
- tachycardia
- hypotension
choose loss of DTR, as a sign of decreased cell excitability.
This occurs because hypoNa means low Na in the extracellular fluid. Fluid then shifts into cells, causing decreasd cell function, and decreased excitability.
***What is the most important cause of post operative ventricular arrythmias?
hypokalemia
replace that shit with KDUR 40 yo!
patient in MVC, found to have tibial fracture and a closed head injury. The patient remains tachycardic and hypotensive despite resuscitation with 2L of crystalloid. What is the most likely cause?
- intra-cranial hemorrhage
- hemorrhage from fracture site
- missed intra-abdominal injury
3) missed abdo injury, their vitals are concerning for hemorrhage
its not 1 because head injury means cushings which is high BP, bradycardic
its not 2 because its a closed fracture and the stem doesnt say there is local swelling or anything
during a lap chole, pt becomes bradycardic to 40. What should the anesthetist give re medicaioin?
atropine - blocks the parasympathetic response
pt with new unstable atrial fibrillation, what should you do?
cardioversion
Pt is post op day 2 TURP, with Na 122 and low BP. What do you do?
give a bolus of NS though some say above Na 120 just fluid restrict + lasix because the issue is dilutional your body absorbs the hypotonic glycine fluid.
only give hypertonic saline if there are neurological manifestations of HypoNa.
A patient presented to the ER and is found to have dead bowel. His INR is 2.5 and he is taking warfarin at home. What should you do?
Give PCC to reverse the INR (intrinsic cascade) and then take to the OR
If a patient was anticoagulated with Rivaroxaban and needs to be reversed for surgery what would you administer?
theres no reversal agent
recall dabigatran, apixaban and rivaroxaban are factor Xa direct inhibitors has
What happens to old stored units of packed RBC’s over time?
- Decreased O2 carrying capacity
- increased 2-3 DPG
- metabolic alkalosis
- decrease K+
3) metabolic alkalosis
How can you prevent the coagulopathy associated with a massive transfusion
- Give a 1:1 or 1:1.5 PRBC to FFP ratio
Clinical scenario describes thyroid storm in a patient. What is the initial treatment?
- Steroids
- Lugol’s solution
- Propythiouracil
- Ablation with radioactive iodine
this question has to be recalled wrong because its a multifactorial treatment:
1) BBlocker- to protect the heart
2) PTU or methimazole - to block new hormone synthesis
3) steroids - to block conversion of T3 to T4
4) iodine solution to block release of T4
