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inservice high yield review > Core > Flashcards

Core Flashcards

1
Q

Rhabdomylysis electrolyte effects

A

lysis of cells leads to hyperkalemia –> can lead to peaked T waves; hyperphosphatemia which binds to calcium resulting in hypocalcemia

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2
Q

cerebral salt wasting vs SIADH

A

Syndrome of inappropriate antidiuretic hormone (SIADH): pass urine with concentrated sodium but increased plama volume

Cerebral salt wasting occurs after intracranial injury. pass lots of urine with sodium and end up volume depleted. It responds to fluid and sodium replacement. It differs from syndrome of inappropriate antidiuretic hormone (SIADH) where you pass urine with concentrated sodium therefore also results in hyponatremia but increased plasma volume:

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3
Q

Curreri formula

A

25kcal/kg/day + 40 kcal/%TBSA/day

should also get 1-2 gm/kg/day of protein

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4
Q

Aspirin (acetylsalic acid)

A

inhibits cyclooxygenase which forms arachidonic acid compounds including thromboxane and prostacyclin. Thromboxane is a platelet aggregator and vasoconstrictor. Prostacyclin is a platelet aggregator.

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5
Q

Dextran

A

polysaccharide decreases platelet aggregation by altering electric charge of platelets and decreases blood viscosity. Also volume expander. Can cause renal injury and pulmonary edema.

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6
Q

Heparin

A

glycosaminoglycan that binds to antithrombin III and enhances its ability to inactivate thrombin (which converts fibrinogen to fibrin), as well as clotting factors IX, X, XI, and XII. May also cause NO-mediated vasodilation.

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7
Q

Hirudin

A

derived from leech Hirudo medicinalis and directly inhibits thrombin.

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8
Q

Streptokinase (first generation) and tissue plasminogen activator (second generation)

A

converts plasminogen to plasmin which breaks down fibrin within a clot

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9
Q

Glycoprotein IIb/IIIa inhibitors

A

antiplatelet agent like aspirin

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10
Q

vonWillebrand disease

A

treat with desmopressin (DDAVP). Can measure levels of von Willebrand factor ristocetin cofactor and coagulation factor VIII. Note DDAVP is a derivative of ADH so restrict fluid to avoid hyponatremia and seizures.

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11
Q

Factor V Leiden

A

most prevalent hypercoagulation disorder. Activated protein C cleaves factor V in three sites; a mutation in the first site is known as factor V Leiden. Factor Va is inactivated 10 times slower than normal.

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12
Q

Protein C and S deficiencies

A

Activated protein C with cofactor protein S inhibits coagulation cascade by inactivating factor V and factor VIIIa. May be associated with warfarin-related skin necrosis and purpura fulminans in neonatal period.

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13
Q

Antiphospholipid syndrome

A

most common acquired coagulation disorder. Autoimmune disorder with antibiodies to phospholipids including anticardiolipin, lupus anticoagulant, anti-beta-2-glycoprotein I.

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14
Q

Tetracyclines

A

contraindicated children under 8, effect growing teeth and bones

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15
Q

Quinolones

A

contraindicated children under 18, effect cartilage and joints

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16
Q

Third generation cephalosporins

A

cefotaxime, cephtriaxone

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17
Q

Antibiotic prophylaxis for leeches

A

aeromonas hydrophila so prophylaxes with fluoroquinolone or in children Bactrim (or ceftriaxone)

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18
Q

Fungal infections

A
  1. Coccidiomycosis (Southwest US)
  2. Histoplasmosis (Ohio-Mississippi river valley)
  3. Blastomycosis (Ohio-Mississippi river valley)
  4. Mucormycosis (rhizopus species)
  5. Crytococcus
  6. Chromomycosis (tropics)
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19
Q

Statistical error

A
  1. Type I: false positive; reject the null hypothesis and falsely conclude there is a treatment effect (guard against with low significance/alpha level of <0.05)
  2. Type II: false negative; failing to reject a null hypothesis that should be rejected due to inadequate sample size/power
  3. Type III: correctly reject the null hypothesis for the wrong reason
  4. Type IV: incorrect interpretation of a correctly rejected hypothesis
20
Q

Levels of evidence

A
  1. High quality, multicentered or single-centered, randomized controlled trial with adequate power
  2. Lesser-quality, randomized controlled trial; prospective cohort study
  3. Retrospective comparative study; case control study
  4. Case series
  5. Expert opinion; case report
21
Q

Autonomic dysreflexia

A

Uncontrolled sympathetic response (headache, hypertension, bradycardia, flushing, blotching, sweating) to stimulus (bladder distention, rectal distention, fractures, heterotopic ossification, dislocations, infections, pregnancy, labor). Patients with paralysis above T6. Treatment to remove stimulus (foley catheter), nifedipine.

22
Q

Malignant hyperthermia

A

caused by inhalational agents like isoflurane and depolarizing muscle relaxants like succinylcholine. Results in skeletal muscle rigidity, tachycardia, fever, cardiac arrhythmias, acidosis, hypotension, hyperthermia, increase in end-expired CO2 concentration. Treat with dantrolene.

23
Q

Succinylcholine side effects

A

only depolarizing muscle relaxant
can trigger malignant hyperthermia
can result in hyperkalemia in paralytics, burns, crush, rhabdomylitis, lower motor neuron injury due to upregulation of nicotinic acetylcholine receptors in denervated or traumatized muscle. Treat with sodium bicarbonate, glucose with insulin, calcium.

24
Q

FENa

A

FENa = ((UNa x PCr)/(PNa x UCr)) x 100% calculates percent of filtered sodium excreted
FENa below 1% prerenal where appropriate reabsorption due to decreased renal perfusion
FENa above 2% inappropriate salt wasting indicating ATN or if intrinsic damage so less sodium reabsorbed. In postrenal disease the FENa is high initially then as there is renal damage the value increases. Diuretics and chronic renal failure alter reliability

25
Q

BUN: serum creatinine ratio

A

BUN reabsorption is regulated whereas creatinine reabsorption is fixed. If prerenal than BUN absorption increased and creatinine stays the same so ratio above 20:1. If renal damage then BUN absorption decreased and ration less than 10:1. If post renal or normal then the ratio will be 10-20:1.

26
Q

neurogenic diabetes insipidus

A

Closed head injury can lead to neurogenic diabetes insipidus. This is due to lack of vasopressin (ADH) production which is produced in the hypothalamus and released by the pituitary. It affects water retention in the collecting ducts and distal convoluted tubule so the patient makes dilute urine with low osmolality and develops hypernatremia.

27
Q

free water deficit

A

free water deficit = normal body water x (1-(serum Na/140)).

28
Q

Keloids

A

excess type III collagen compared to type I. Increased transforming growth factor beta (TGF-B).

29
Q

Aprepitant

A

highly selective brain-penetrant, neurokinin-1 receptor antagonist. Block the binding of substance P at the neurokinin-1 receptor in brain stem emetic center and GI tract. Long half-life.

30
Q

Ondanstron/Zofran

A

serotonin (5-HT3 receptor) antagonist effect chemoreceptor trigger zone and vagal afferents in GI tract

31
Q

Droperidol

A

blocks dopamine receptors

32
Q

Promethazine

A

central antidopaminergic mechanism

33
Q

Metoclopramide

A

blocks dopamine receptors in central vomiting center and can block serotonin receptors in high doses

34
Q

Preoperative guidelines for cardiac workup

A

Asymptomatic patient underoing elective, non-cardiac surgery who can perform moderate physical activity (4 mets like walking up two flights of stairs) then no further cardiac testing needed.

35
Q

Treatment of MI

A

MOAN (morphine, oxygen, aspirin, nitroglycerin…and angiocath)

a. Can have asymptomatic ventricular premature beats and nonsustained ventricular tachycardia on monitoring but don’t treat of hemodynamically stable
b. If unstable or ventricular fibrillation or symptomatic sustained ventricular tachyarrhythmia then defibrillation and/or amiodarone

36
Q

Bradycardia

A

treated with atropine, only if causing symptomatic hypotension

37
Q

Narrow complex supraventricular tachycardia

A

treat with adenosine

38
Q

tosades de pointes

A

treat with magnesium. Caused by digoxin toxicity or low magnesium

39
Q

nerve fibers

A

alpha: large; proprioception, large motor
beta: small motor, touch pressure
gamma: muscle tone
delta: small; pain, temperature, touch
unmylenated: small; dull pain, temperature, touch
smaller nerves affected by blocks earlier

40
Q

merkel cell

A

in epidermis, derived from neural crest

constant touch and pressure, static two-point discrimination

41
Q

meissners corpuscle

A

in dermis

light touch, dynamic two-point discrimination

42
Q

pacinian corpuscle

A

in dermis

vibration, deep pressure

43
Q

bulb of Krause

A

in dermis

temperature (cold)

44
Q

ruffini ending

A

in dermis

sustained pressure, temperature (hot)

45
Q

Baux score

A

50% mortality if age + TBSA = 110

if inhalation injury then if =100

46
Q

biobrane/trancyte

A

biobrane: nylon fabric coated with porcine dermal collagen with silicone membrane
trancyte: add neonate fibroblasts

inservice high yield review (5 decks)

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