Absite new Flashcards
Heparin MOA ?
Heparin activates AT-III (up to 1000× normal activity).
AT-III MOA ?
Inhibits Thrombin, factor 9,10 and 11
Protein C & S MOA ?
protein c degrades factor 5 and 8 and fibrinogen
protein S is a cofactor for protein c
Only factor not synthesized in the liver?
factor 8
DDAVP function?
Causes the release of vwf and factor 8 from the endothelium
cryoprecipitate content?
has the highest concentration of vWf and factor8
Heparin-induced thrombocytopenia (HIT) pathophysiology
Thrombocytopenia due to anti-heparin antibodies (IgG heparin-PF4
antibody) results in platelet destruction
patients with coronary stents and on plavix the need to undergo surgery what do u do?
you can stop plavix 7 days prior to surgery and bridge the patient on eptifibatide [GpIIb/IIIa inhibitor]
ε-aminocaproic acid MOA ?
inhibits fibrinolysis
the best way to detect bleeding risk prior to surgery is through?
history and physical exam
factor V leiden mutation pathophysiology?
defect on factor V makes it resistant to activated protein C
Most common cause of acquired hypercoagulable state is ?
Smoking
Dabigatran (pradaxa) MOA ?
Direct thrombin inhibitor
Tx of HITT (Heparin Induced Thrombocytopenic Thrombosis) ?
STOP the heparin and add Argatroban (direct thrombin inhibitor)
MCC of death from transfusion reaction?
TRALI (Transfusion related Acute Lung Injury)
Most abundant antibody is ?
IgG
Type 1 hypersensitivity reaction example ?
bee stings, penut allergy, hay fever
Type 2 hypersensitivity reaction example?
ABO incompatibility
Hyperacute rejection
myasthenia gravis
Type 3 hypersensitivity
reaction example?
serum sickness
SLE
(immune complex deposition)
What are tetanus prone wounds ?
(> 6 hours old; obvious contamination and
devitalized tissue; crush, burn, frostbite, or missile injuries)
when to give tetanus immunoglobulin in addition to vaccine?
(given intramuscular near wound site) – give
only with tetanus-prone wounds in patients who have not been immunized
or if immunization status is unknown
Most common immunodefeciency leading to infection is ?
Malnutrition
Most common anaerobe in the colon ?
Bacteroides Fragilis
Most common aerobic bacteria in the colon?
E.coli
Arrange fever causes sequentially over time
Fever sources (sequentially over time) – atelectasis, urinary tract
infection, pneumonia, DVT, wound infection, intra-abdominal abscess
Most common organism overall in surgical site infections
Staph aureus
Most common GNR in surgical wound infections
E.coli
most common aneorobe in surgical wound infections
Bacteroides Fragilis
Risk factor for SSI ?
Surgical factors: Long operations, Hemtoma or seroma formation
Patient factors: Advanced age, chronic disease, malnutrition, DM, Imunnosuppressive medication
Organisms associated with Necrotizing fascitis?
Beta henolytic (group A) strep
MRSA
characterisitc gram stain for Actinomyces?
Yellow sulfur granules on gram stain
MCC of fungemia?
Candida
Diagnosis of Spontaneous Bacterial peritonitis?
peritoneal fluid with PMN >250 or positive culture (50% ecoli, 30% streptococcus, 10% klebsiella)
Most common indication for liver transplantation is ?
Hepatits C
MC site of aspiration pneumonia in lungs?
superior segment of the right lower lobe
What are the bacteriostatic antibiotics?
tetracycline, clindamycin, erythromycin (all
have reversible ribosomal binding),
TMX-SMZ
Most common method of antibiotic resistance?
Transfer of plasmid
MCC of intraop bradycardia
inhalational anasthesia
which inhalational agent in anasthesia is good for neurosurgery?
Isoflurane – good for neurosurgery (lowers brain O2 consumption; no
increase in ICP)
last muscle to go down and 1st muscle to recover from
paralytics
Diaphragm
1st muscle to go down and last muscle to recover from paralytics
Muscles of the neck and face
which muscle relaxant undergoes hoffman elimination(elmination in blood and tissues)?
Cis-atrcurium
which muscle relaxant is the fastest?
Rocuronium
sugammadex reversal agent for which muscle relaxnats?
Rocuronium
Vecuronium
Maximum dosing of local anasthetics?
- Lidocaine 4 mg/kg (7 mg/kg with epi)
- Bupivacaine 2 mg/kg (3 mg/kg with epi)
Amides (all have an “i” in first part of the name)
lidocaine,
bupivacaine, mepivacaine; rarely cause allergic reactions
Esters of local anasthetics
tetracaine, procaine, cocaine; ↑ allergic reactions due to PABA
analogue
Opiods MOA?
CNS mu-receptor agonists
Combination of MOAI and opiods can lead to?
hyperpyrexic coma (serotonin release syndrome – fever,
tachycardia, seizures, coma)
Epidural insertion site for thoracotomy vs laparatomy?
Thoracotomy insertion level: T6–T9
Laparotomy insertion level: T8–T10
how to calculate serum osmolarity?
(2*NA)+(gluscose/18)+(BUN/2.8)
normal value (280-295)
Insensible fluid loss
10 cc/kg/day; 75% skin (#1; sweat), 25%
respiratory, pure water
GI fluid secretions amount for stomach, duodenum, pancreas and biliary system
● Stomach 1–2 L/day
● Biliary system 500–1,000 mL/day
● Pancreas 500–1,000 mL/day
● Duodenum 500–1,000 mL/day
highest concentration of potassium the body is in?
SALIVA
You need to replace Magnesium before correcting what electrolytes?
Potassium and calcium
Symptoms of hypernatremai?
PATIENT is HYPER :D
he is restless and irritable and is having seizures
Tx of refractory and severe SIADH?
conivaptan, tolvaptan (competitive
antagonist for kidney V2 receptor)
High anion gap acidosis causes?
“MUDPILES” = methanol, uremia, diabetic ketoacidosis, paraldehydes,
isoniazid, lactic acidosis, ethylene glycol, salicylates
Whats increases caloric needs ?
trauma sepsis surgery
burn
pregnancy
lactation
How to calculate calories and protein for burn patients?
- Calories: 25 kcal/kg/day + (30 kcal/day × % burn)
- Protein: 1–1.5 g/kg/day + (3 g/day × % burn)
- Don’t exceed 3,000 kcal/day.
Fuel for small bowel eneterocytes?
glutamine
fuel for colonocytes?
short chain fatty acids
obligate glucose users?
Blood, Renal medulla, Brain, Bone marrow
Glycogen stores can supply the body with glucose for how long ?
12-24hours
Preoperative low serum albumin is associated with postoperative
increase mortality and morbidity
The best acute indicator of nutritional status is ?
prealbumin
Harris–Benedict equation calculates basal energy expenditure based on what parameters?
Age,height, weight and gender
Preooperative nutrition is indicated in ?
indicated only for patients with severe malnutrition
undergoing major abdominal or thoracic procedures.
At what day symptoms of refeeding syndrome usually after after initiating feeding?
Day 4
what are micelles?
ggregates of bile salts, long-chain free fatty acids, and
monoacylglycerides
* Enter enterocyte by fusing with membrane
* Bile salts – increase absorption area for fats, helping form micelles
* Cholesterol – used to synthesize bile salts
* Fat-soluble vitamins (A, D, E, K) – absorbed in micelles
Essential fatty acids
linolenic, linoleic
Non-essential amino acids
those that start with A, G, or C plus serine, tyrosine,
and proline
METABOLIC SYNDROME (NEED 3 to diagnose)
● Waist circumference (> 40 inches in men, > 35 inches in women)
● Insulin resistance (fasting glucose > 100)
● High TAGs (> 150)
● Low HDL (< 40 in men, < 50 in women)
● Hypertension(>130/85)
Most important prognostic indicator for lung CA and breast CA
nodal status
Most important prognostic indicator for sarcoma
Tumor grade
testicular CA, choriocarcinoma tumor marker
B-HCG
folinic acid with methotrexate vs 5FU
with methotrexate its reverse the effect
with 5FU it augments the effect
Cisplatinum s/e
nephrotoxic, neurotoxic and ototoxic
chemotheraputic agents that causes myelosuppression
vinblastine
carboplatin
prophylactic thyroidectomy is done in
patients with RET proto-oncogene with familt history of thyroid CA
examples of tumor suppressor genes
RB1
APC
p53
DCC
BRCA
bcl
Li–Fraumeni syndrome
defect in p53 gene → patients get childhood
sarcomas, breast CA, brain tumors, leukemia, adrenal CA
Cowden syndrome
defect in PTEN gene; get benign hamartomas
(skin, mucus membranes, GI tract); increased risk for CA (usually
thyroid, breast, and endometrial CA)
Hereditary diffuse gastric cancer gene defect
Defect in CDH1 gene
Genes involved in colon CA
APC, p53, DCC, and K-ras.
which type of cancer metastasise to small bowel
melanoma
Most common malignancy following transplant?
Skin cancer (Squamous skin cancer)
2nd MC malignancy following transplant?
Posttransplant lympho-proliferative disorder (PTLD) – next most
common malignancy following transplant (Epstein-Barr virus related)
Azathioprine and mycophenolate MOA
Inhibits de novo purine synthesis, which inhibits growth of T cells
Cyclosporine MOA?
Binds cyclophilin protein; CSA-cyclophilin complex then inhibits
calcineurin, which results in decreased cytokine synthesis (IL-2 most importantly)
FK-506 (Prograf, tacrolimus) MOA?
Binds FK-binding protein; actions similar to CSA but more potent
Sirolimus MOA ?
Binds FK-binding protein like FK-506 but inhibits mammalian
target of rapamycin (mTOR); result is that it inhibits T and B cell
response to IL-2
Anti-thymocyte globulin (ATG) MOA?
polyclonal antibodies
against T-cell antigens (CD2, CD3, CD4)
* Used for induction and acute rejection episodes
Side effect profile of Anti-thymocyte globulin (ATG)
Side effects:
*cytokine release syndrome (fever, chills, pulmonary
edema, shock) – steroids and Benadryl given before drug to try to
prevent this
*PTLD
*Myelosuppression
You can store the kidney before transplant for how long ?
48 hours
Most common complication following kidney transplant?
urine leaks
New proteinuria post kidney transplant suggest?
renal vein thrombosis
you can store liver for how long before transplantation?
24 hours
Most common reason for liver transplant?
chronic hep C