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SURGX > ABS1 > Flashcards

ABS1 Flashcards

1
Q

TBW in adult females

A

50%

*Males = 60%

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2
Q

Clinical manifestations of hypokalemia are primarily related to

A

Failure of normal contractility of GI smooth muscle (ileus, constipation) skeletal muscle (decreased reflexes, weakness, paralysis), and cardiac muscle (arrest)

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3
Q

Parameters in Harris-Benedict equation

A

W = actual weigh in kg
H = actual height in cm
A = age in years

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4
Q

The most abundant amino acid in the human body

A

Glutamine

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5
Q

Nutritional formula used to treat pulmonary failure typically increase the fat intake of a patient’s total caloric intake to

A

50%

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6
Q

Early sign of hyperkalemia

A

Peaked T waves

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7
Q

Normal saline is

A

154 mEq NaCl/L

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8
Q

Fluid resuscitation for hypovolemic shock using albumin can lead to

A

Pulmonary edema

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9
Q

Hydroxyethyl starch solutions are associated with

A

Postoperative bleeding (in cardiac and neurosurgery patients)

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10
Q

Water constitutes what percentage of total body weight

A

50–60%

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11
Q

A cation exchange resin that binds potassium, either given enterally or as an enema

A

Kayexalate

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12
Q

A patient who has spasms in the hand when a blood pressure cuff is blown up most likely has

A

Hypocalcemia

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13
Q

The effective osmotic pressure between the plasma and interstitial fluid compartment is primarily controlled by

A

Protein

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14
Q

The metabolic derangement most commonly seen in patients with profuse vomiting

A

Hypochloremic, hypokalemic metabolic acidosis

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15
Q

Best determinant of whether a patient has a metabolic acidosis versus alkalosis

A

Arterial pH

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16
Q

Excessive administration of normal saline for fluid resuscitation can lead to what metabolic derangement

A

Metabolic acidosis

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17
Q

The first step in the management of acute hypercalcemia should be

A

Correction of deficit of extracellular fluid volume

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18
Q

The vagus nerve mediates which in the setting of systemic inflammation

A

The vagus nerve exerts several homeostatic influences including:
Enhancing gut motility
Reducing heart rate
Regulating inflammation

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19
Q

Cytokines are what type of hormone

A

Polypeptide

*Polypeptide = Cytokines, glucagon, and insulin
*Amino acids = Epinephrine, serotonin, and histamine
*Fatty acids = Glucocorticoids, prostaglandins, and leukotrienes
*NO carbohydrate hormones

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20
Q

Function of heat shock proteins

A

Binding of autologous proteins to improve ligand binding

*HSPs bind both autologous and foreign proteins and thereby function as intracellular chaperones for ligands such as bacterial DNA and endotoxin

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21
Q

Eicosanoids

A

Prostaglandins, prostacyclins, hydroxyeicosatetraenoic acids (HETEs), thromboxanes, and leukotrienes

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22
Q

Omega-3 fatty acids have what effects on the inflammatory response

A

Decreased inflammatory response

*In a study of surgical patients, preoperative supplementation with omega-3 fatty acid was associated with:
Reduced need for mechanical ventilation
Decreased hospital length of stay
Decreased mortality with a good safety profile

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23
Q

Known effects of tumor necrosis factor (TNF)

A

Enhances the expression of eicosanoids

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24
Q

Are adhesion molecules (i.e., cells that mediate leukocyte to endothelial adhesion)

A

L-selectin

There are 4 families of adhesions molecules:
Selectins
Immunoglobulins
Beta (CD18) integrins
Beta (CD29) integrins

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25
Q

The primary physiologic effect of nitric oxide (NO) is

A

Increased smooth muscle relaxation

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26
Q

Prostacyclin has what effects in systemic inflammation

A

Inhibition of platelet aggregation

*Prostacyclin is an effective vasodilator and also inhibits platelet aggregation
*Primarily produced by endothelial cells

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27
Q

If 1 liter of 0.9% NaCl solution is given intravenously, how much will be distributed to the interstitial space

A

750 cc

*Sodium is confined to the ECF compartment, and because of its osmotic and electrical properties, it remain associated with water
*One liter of normal saline will be distributed 3:1 to the interstitial space – 750 mL to the interstitial space and 250 mL will remain in the intravascular volume

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28
Q

The principal determinants of osmolality are the concentrations of

A

Sodium, glucose, and urea (or BUN)

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29
Q

A patient develops a high output fistula following abdominal surgery. The fluid is sent for evaluation with the following results: Na 135, K 5, Cl 70. Most likely source of the fistula

A

Pancreas

*Composition of GI Secretions

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30
Q

What diagnosis would be most likely in a patient who presents with normovolemic hyponatremia

A

Syndrome of inappropriate anti-diuretic hormone secretion (SIADH)

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31
Q

A patient is admitted with a glucose of 500 and a sodium of 151. Best approximation of the patient’s actual serum sodium level is

A

145

*For every 100 mg/dL increment in plasma glucose above normal, the plasma sodium should decrease 1.6 mEq/L
*For this patient, serum glucose of 500 is roughly 400 mg/dL above normal: 4 x 1.6 = 6.4 subtracted from 151 to obtain a corrected serum sodium of 144.6

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32
Q

Most likely diagnosis in a patient with serum sodium of 152 mEq/L, a urine sodium concentration of >20 mEq/L, and a urine osmolality of >300 mOsm/L

A

Cushing’s syndrome

*Hypervolemic hypernatremia usually is caused either by:
Iatrogenic administration of sodium-containing fluids, including sodium bicarbonate
Mineralocorticoid excess – hyperaldosteronism, Cushing’s syndrome, and congenital adrenal hyperplasia

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33
Q

Medications that can contribute to hyperkalemia, particularly in the presence of renal insufficiency

A

Potassium-sparing diuretics
Angiotensin-converting enzyme inhibitors
NSAIDs

*Aspirin and CCBs have no significant effect on potassium levels

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34
Q

Which metabolic electrolyte imbalance would cause decreased deep tendon reflexes

A

Hypokalemia

*Hypomagnesemia and hypocalemia cause increased deep tendon reflexes

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35
Q

Is an early ECG change seen in hyperkalemia

A

Peaked T waves

*ECG changes that may be seen with hyperkalemia include:
High peaked T waves (early)
Widened QRS complex
Flattened P wave
Prolonged PR interval (first-degree block)
Sine wave formation
Ventricular fibrillation

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36
Q

A postoperative patient with a potassium of 2.9 is given 1 mEQ/kg replacement with KCl (potassium chloride). Repeat test after the replacement show the serum K to be 3.0. The most likely diagnosis is

A

Hypomagnesemia

*In case in which potassium deficiency is due to magnesium depletion, potassium repletion is difficult unless hypomagnesemia is first corrected

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37
Q

What is the actual serum calcium level in a patient with an albumin of 2.0 and a serum calcium level of 6.6

A

8.2

*Adjust total serum calcium down by 0.8 mg/dL for every 1 g/dL decrease in albumin: 0.8 x 2 = 1.6 + 6.6 = 8.2

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38
Q

Hypomagnesemia clinically resembles

A

Hypocalcemia

39
Q

A patient presents obtunded to the ER with the following labs: Na 130, Cl 105, K 3.2, HCO3 15. Most likely diagnosis is

A

GI losses

*This is a normal anion gap acidosis

40
Q

Should be the first treatment administered to a patient with potassium level of 6.3 and flattened P waves on their ECG

A

Insulin and glucose

*The goal of therapy include reducing the total body potassium, shifting potassium from the extracellular to the intracellular space, and protecting the cells from the effects of increased potassium
*Treatment of symptomatic hyperkalemia:
Potassium removal – Kayexalate, dialysis
Shift potassium – Glucose, insulin, bicarbonate
Counteract cardiac effects – Calcium gluconate

41
Q

Basal caloric requirement of a normal healthy adult

A

25-30 kcal/kg/day

42
Q

Deficiency often due to malabsorption from prior gastric surgery (e.g., bariatric surgery)

A

Acquired copper deficiency

*Hypochromic microcytic anemia occurs from copper deficiency-induced impairment of iron absorption

43
Q

Characteristics of central parenteral nutrition includes

A

 Dextrose content: 15-25%
 High osmolarity (1500-2800 mOsm/L)
 Requires administration into large veins with high blood flow (2- 6 L/min)
 Provides complete nutritional requirements

44
Q

Primary source of calories during acute starvation (<5 days fasting) is

A

Fat

45
Q

Primary fuel source in prolonged starvation

A

Ketone bodies

46
Q

Primary fuel source after acute injury

A

Fat

47
Q

Sepsis increases metabolic needs by approximately what percentage

A

50%

48
Q

Most abundant amino acid in the human body

A

GlutaMINE
*Synthesized within the skeletal muscles (70%) and the lungs
*Precursor for glutathione

49
Q

Cortisol is elevated in response to severe injury. How long can this response persist in a patient with a significant burn

A

1 month or 4 weeks

50
Q

What vitamin can be used to mitigate cortisol effects on wound healing

A

Vitamin A

*Cortisol reduces TGF-β and IGF-I in the wound → Impaired wound healing

51
Q

Laboratory findings in adrenal insufficiency

A
  • Hypoglycemia – from decreased gluconeogenesis
  • Hyponatremia – from impaired renal tubular sodium resorption
  • Hyperkalemia – from diminished kaliuresis
  • Calcium levels – not affected
52
Q

Overfeeding (RQ>1) in a critically ill patient can result in

A

Increased risk of infection

53
Q

Initial enteral formula for the majority of surgical patients

A

Low-residue isotonic formula

54
Q

Which nutrient is proportionally increased in “pulmonary failure” enteral formula

A

Fat

*The goal is to reduce carbon dioxide production and alleviate ventilation burden for failing lungs

55
Q

Which vitamin is not present in commercially prepared intravenous vitamin preparations and, therefore, must be supplemented in a patient receiving TPN

A

Vitamin K

*Should be supplemented on a weekly basis

56
Q

New onset of glucose intolerance in a TPN dependent patient can be due to

A

Chromium deficiency

57
Q

A potential physiologic effect of anabolism (positive nitrogen balance)

A

Glycosuria

*Anabolism requires a large shift of potassium into the new cells – leading to serum hypokalemia
*Hypokalemia may cause glycosuria – treated with potassium, not insulin
*Before giving insulin, the serum potassium level must be checked to avoid exacerbating the hypokalemia

58
Q

The only anticoagulant reversal agent for dabigatran

A

Idarucizumab

59
Q

Most common adverse transfusion reaction

A

Febrile nonhemolytic transfusion reaction (FNHTR)

*Prevention is best achieved by using leukoreduced blood products for future transfusions

60
Q

Minimum threshold for transfusion for hemodynamically stable patients

A

7 g/dL

61
Q

Minimum threshold for transfusion for patients undergoing cardiac surgery, orthopaedic surgery, and with pre-existing CVD

A

8 g/dL

62
Q

The vitamin K-dependent coagulation factors are

A

Factors II, VII, IX, X, proteins C and S

63
Q

Required for platelet adherence to injured endothelium

A

von Willebrand factor (vWF)

*vWF binds to glycoprotein (GP) I/IX/V on the platelet membrane

64
Q

The first factor common to both intrinsic and extrinsic pathway

A

Factor X (Stuart-Prower factor)

65
Q

What congenital factor deficiency is associated with delayed bleeding after initial hemostasis

A

Factor XIII

66
Q

In a previously unexposed patient, when does the platelet count fall in heparin-induced thrombocytopenia (HIT)

A

5-7 days

67
Q

Best laboratory test for determining the degree of anticoagulation with dabigatran and rivaroxaban

A

None

68
Q

Most common intrinsic platelet defect

A

Storage pool disease

69
Q

Leading cause of transfusion-related deaths

A

Transfusion-related acute lung injury

70
Q

Most common cause for transfusion reaction is

A

Human error

71
Q

Frozen plasma prepared from freshly donated blood is necessary when a patient requires

A

Factor VIII (antihemophilic factor) or factor V (proaccelerin)

72
Q

What clotting factor is labile, and 60-80% of activity is gone 1 week after collection

A

Factor VIII

73
Q

Best choice to prepare a patient with type I von Willebrand’s disease for surgery

A

Desmopressin

*vWD is classified into three types:
* Type I – Partial quantitative deficiency = Desmopressin acetate
* Type II – Qualitative defect = May respond depending on particular defect
* Type III – Total deficiency = Usually unresponsive
*Treatment for vWD:
 An intermediate-purity factor VIII concentrate such as Humate-P that contains vWF as well as factor VIII
 Desmopressin acetate – raises endogenous vWF levels by triggering release of the factor from endothelial cells

74
Q

Hemophilia C is caused by a deficiency of

A

Factor XI

*Treatment: Fresh-frozen plasma (FFP) – each mL of plasma contains 1 unit of factor XI activity

75
Q

Factor XIII deficiency most commonly present as

A

Delayed bleeding after injury or surgery

*Bleeding typically is delayed, because clots form normally but are susceptible to fibrinolysis
*Treatment: FFP, cryoprecipitate, or a factor XIII concentrate

76
Q

Bleeding in patients with thrombasthenia is treated with

A

Platelet transfusion

*Thrombasthenia or Glanzmann thrombasthenia – either lacking or present but dysfunctional platelet glycoprotein IIb/IIIa complex → leads to faulty platelet aggregation and subsequent bleeding

77
Q

Bleeding in patients with the Bernard-Soulier syndrome is treated with

A

Platelet transfusion

*Caused by a defect in the glycoprotein Ib/IX/V receptor for vWF, is necessary for platelet adhesion to the subendothelium

78
Q

A patient with partial albinism and a bleeding disorder most likely has

A

Dense granule deficiency

*The most common intrinsic platelet defect is storage pool disease – involves loss of dense granules (storage sites for ADP, adenosine triphosphate (ATP), Ca2+, and inoerganic phosphate) and α-granules
*Treatment: Desmopressin acetate, platelet transfusion with more severe bleeding

79
Q

First line therapy in an adult with idiopathic thrombocytopenia purpura includes

A

IV immunoglobulin

*First line therapy for ITP in adults is = Corticosteroids and IV immunoglobulin
*Splenectomy is second line therapy
*Desmopressin is not used in the treatment of ITP

80
Q

The diagnosis of heparin-induced thrombocytopenia is made by

A

Positive serotonin release assay or an enzyme-linked immunosorbent assay (ELISA)

81
Q

In addition to stopping the heparin, a patient with heparin-induced thrombocytopenia (HIT) should be treated with

A

Lepirudin

*Stopping heparin without adding another anticoagulant is not adequate to prevent thrombosis
*Alternative anticoagulants are primarily thrombin inhibitors = Lepirudin, argatroban, bivalirudin, danaparoid
*Because of warfarin’s early induction of a hypercoagulable state, only once full anticoagulation with an alternative agent has been accomplished and the platelet count has begun to recover should warfarin be instituted

82
Q

The most effective treatment for bleeding secondary to thrombotic thrombocytopenic purpura is

A

Plasmapheresis
*Platelet transfusions are contraindicated

83
Q

In a 70-kg patient, transfusion of 1 unit of platelets should raise the circulating platelet count by approximately

A

10,000

*One unit of platelet concentrate contains approximately 5.5 x 1010 platelets

84
Q

Which is a common initiating event for disseminated intravascular coagulation (DIC)

A

Amniotic fluid embolization

*Embolized materials are potent thromboplastins that activate the DIC cascade
*The presence of an underlying condition that predisposes a patient to DIC is required for the diagnosis
 CNS injuries with embolization of brain matter
 Fractures with embolization of bone marrow
 Amniotic fluid embolization
 Malignancy
 Organ injury (such as severe pancreatitis)
 Liver failure
 Certain vascular abnormalities (such as large aneurysms)
 Snakebites
 Illicit drugs
 Transfusion reactions
 Transplant rejections
 Sepsis

85
Q

A patient with prolonged aPTT and deep venous thrombosis should be evaluated for what condition

A

Antiphospholipid syndrome

*The hallmark of antiphospholipid syndrome (APLS) is – prolonged aPTT in vitro but an increased risk of thrombosis in vivo

86
Q

A patient on chronic warfarin therapy presents with acute appendicitis. INR is 1.4. Most appropriate management

A

Proceed immediately with surgery without stopping the warfarin

87
Q

Which devices is most advantageous for hemostasis during a thyroidectomy

A

Harmonic scalpel
*Harmonic scalpel – cuts and coagulates tissue via vibration at 55 kHz (converts electrical energy into mechanical motion) → the motion of the blade causes collagen molecules within the tissue to become denatured, forming a coagulum
 Thyroidectomy
 Hemorrhoidectomy
 Transection of the short gastric veins during splenectomy
 Transecting hepatic parenchyma

88
Q

Topical anticoagulating agent that is best for use in patients with a coagulopathy

A

Fibrin sealant

89
Q

What percent of the population is Rh negative

A

15%

90
Q

What is the maximum number of units of blood that can be autologously donated for elective surgery as long as the patient’s haemoglobin is >11 g/dL or if the haematocrit is >34%

A

5 donations can be made, 3-4 days apart, starting 6 weeks before surgery

91
Q

Best assess clot strength

A

Thromboelastogram (TEG)

*The only test measuring all dynamic steps of clot formation until eventual clot lysis or retraction

92
Q

When should cryoprecipitate be given to a patient needing a massive transfusion of packed RBCs

A

After 6 units of PRBCs, cryoprecipitate should be given if the serum fibrinogen level is <100 mg/dL

93
Q

↓ Warfarin effect
↑ Warfarin requirements

A

Barbiturates, oral contraceptives, estrogen-containing compounds, corticosteroids, adrenocorticotropic hormone

94
Q

↑ Warfarin effect
↓ Warfarin requirements

A

Phenylbutazone, clofibrate, anabolic steroids, L-thyroxine, glucagons, amiodarone, quinidine, cephalosporins

SURGX (7 decks)

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