Clerkships-SURGERY Flashcards
How does PEEP increase oxygenation?
Increases FRC
First step in HIT, second step
Stop heparin
- Give a direct thrombin inhibitor such as
Argatroban, lepirudin
Progression of retinal detachment
First 20 question
NBT pancreatic adenoca
Ultrasound guided endoscopic biopsy
Wallenberg
PICA
Comminuted occipital condyle fracture
Hypoglossal palsy
kyphoplasty
puts cement in the vertebra to offer compression fracture relief
first step in treating PE
IVC filter (not heparinization, not thombolytic)
tx for biliary atresia
And PSC
liver transplant
Gallbladder path assoc. w UC
Primary sclerosis cholangitis
Pbc is only medium sized
Fibromuscular dysplasia
Renal artery stenosis/htn
Carotid dissection
“String of beads”
tx: stent and angioplasty
Amarousis fugax
?
“Salty” found in csf
Tau protein (beta-2 transferrin)
Cilostazol used only for
Peripheral artery disease
ABSOLUTE contraindication to surgery
DKA
Surgical abx ppx timing?
Choice of abx and target?
1 hour prior to surgical incision
+intra-operative dose for 6+ hr surgeries
cefazolin (kefzol) for GRAM+ COCCI (staph, etc., skin flora)
Which abx is the culprit in causing infectious colitis
clindamycin (kills “good” flora)
NBS in anuric kidney transplant patient
biopsy the allograft (suspect acute graft rejection)
next best step in TIA?
aspirin 1300mg/day
What to look for in munchhausen’s/factitious hyperinsulinemia
NORMAL C-peptide. remember, it would be elevated in real insulinoma
Tumor marker in pancreatic cancer
GIST? MEN2A/B, medullary thyroid Small cell lung Burkitts Neurofibromatosis Schwannoma Hepatocellular Colorectal
k-ras, CA19-9
C-kit ret L-myc, neuron specific enolase C-myc Nf1 Nf2 AFP, ferritin CEA
NBS in pyelonephritis
foley
Indications for hemodialysis
AEIOU
acidemia, electrolyte disorder, intoxication (lithium, ethylene glycol), overload of fluid (Pleural effusion periph edema, pulmonary edema) , uremia
Tx for benign essential tremor
Deep brain stim of thalamus
Uremic coagulopathy
Nephrotic syndrome?
Look for elevated bun/cr and that might lead to platelet dysfunction
Hypercoaguable! Lose ATIII in proteinuria
Hyperextention neck injury in the setting of stenosis
Central cord syndrome Loss of UL motor, preservation of LL motor
BBS in gross hematuria
CT a/pelvis with contrast for suspected bladder cancer
Protamine
FFP
Cryoprecipitate
Heparin reversal
Warfarin reversal
When fibrinogen is low/massive transfusions/ tPA admin.
DVTs happen most commonly where
Femoral v
Which clotting factor is not made by the liver
VIII
Cauda equina syndrome
Saddle anesthesia
Urinary retention
Weakness
Alpha 1 antitripsin liver characteristics
Intracellular red hyaline globules on PAS
Hepatic Adenoma
Likely to rupture and bleed
Assoc with oral contraceptives
Post splenectomy sepsis
Strep pneumo
Preferred way to get someone’s nutritional status up?
Enteral Feeds
Biggest predictor of peri-operative mortality? How to evaluate? Cutoff?
CHF; measure EF w/ echo; <35% postpone surgery
NBS for all three neck zone trauma
Zone II always surgery
Zone I esophagram
Zone III arteriogram
If a patient has had LOC at ANY POINT, NBS
CT head (after airway, etc. )
Cushing’s treflex triad
Bradycardia, widened pulse pressure, irregular breathing
in the setting of elevated ICP
What to do if someone has trouble voiding after surgery
Slow the rate of fluid admin intraoperatively
In addition to abx what do you give for meningitis
steroids
Broca’s area/expressive aphasia what area of the brain?
Inferior frontal gyrus
Low urine output in elderly? Workup?
Renal ultrasound (but fluid bolus for younger people/prerenal)
Not fluids in this case bc of risk of CHF exacerbation, etc.
RCC is assoc. with what syndrome
VHL
Most common cause of death following myocardial contusion
Vfib
NBS for blunt trauma to kidney
CT
Priority of limb injury
1) bone 2) vessel (delay causes compartment) 3) nerve
A-V fistulas are assoc. with what cardiac abn.
high output cardiac failure
Cavernous malformation on MRI
popcorn lesion
Confirmatory test for “echinococcal/hydatid cyst”
ELISA
Temporal lobe hernia
Subfalcine Hernia
3rd nerve palsy
anterior cerebral artery occlusion
Short and externally rotated leg vs internally rotated leg
EXternally rotated, femoral hEad fracture
Internally rotated, posterior dislocation of the hip
What condition classically resolves when leaning forward (using a cans or pushing a cart etc)
Lumbar stenosis (don’t confuse with PVD)
Transfusion related acute lung injury
Too much transfusion. White out. Looks like ards.
Arm symptoms normally, but also dizziness/speech issues when exercising that arm. Path? Dx? Tx?
Subclavian steal syndrome, athero of the sublavian before it gives off the vertebral a. Reversal of flow thru vertebral.
dx- arteriogram
tx - surg bypass
Wealthy man who is retired has claudication after walking 15 blocks. NBS?
nothing. Only workup if it affects the person’s life
IVF maintenance of choice?
When to use other stuff?
D5 1/2 normal saline
Extremes: hypertonic and hypotonic (D5W) in acute hyponatremia and acute hypernatremia, respectively.
Fluid restriction for chronic hyponatremia.
Isotonic-normal saline for alkalotic “natremia.” Isotonic-LR for acidotic “natremia.”
What to check in CO poisoning?
CARBOXYHEMOGLOBIN (not pulse ox; worthless because it’s an unloading issue)
NBS in electrical burn
EKG
how do you treat flail chest
nerve block
Contraindications to FNA?
Drainage of abcess?
Liver hemangioma, scrotal mass (could spread the SSC)
Lung abcess, liver (amoebic) abscess.
note: echinococcal cyst (tx with albendazole/etOH then surgery)
tx for incisional infection?
NO ABX.
Vitamin deficiency w/ carcinoid?
Niacin. (serotonin/tryptophan derivative).
Diarrhea, dermatitis, dementia
