Final Written Exam Flashcards
Prostate cancer surgery best anticoagulant
subQ LMW heparin
enlarging mass in breast of pregnant woman first step
excisional bx
MELD score components (3)
bic
Billi
INR
Creatinine
Murmur likely to increase risk of operative complications
S3 gallop
Perioperative insulin regimen
1/2 usual dose long actin AM of surgery
Anesthetic that produces life threatening hyperkalemia
succinylcholine
Who gets pre-op ECG
older male being evaluated for CEA
Hypocalcemia symptom
carpopedal spasm
How to replace fluid lost from fistula
lactated ringers
Bile composition ~
Na 130
K 4.0
Cl 100
Bicarb 25
Large bilious drainage from drain at gastrojejunostomy site likely =
leak from duodenal stump
Pyloric stenosis metabolic derangement
hypochloremic hypokalemic metabolic alkalosis
TPN for anorexia –> proximal muscle and visual deficits =
hypophosphatemia
SIADH management
water restriction to less than 1000ml/day
Hyponatremia + hyperglycemia management
hyponatremia not initially management because high glucose creates dilutional effects
4 days of N/V most important labs
electrolytes
Perforated duodenal ulcer = high risk of
nutritional deficiency because all shit is absorbed there
Where in the GI tract is iron absorbed?
jejunum
Which lab reflects protein anabolism
pre-albumin
Most oral meds are absorbed ____
in duodenum
Two signs of refeeding syndrome
anemia + respiratory distress
which macronutrient groups have lowest/ highest kilocals
lipids high –> proteins –> carbs low
Major cause of cachexia in short bowel syndrome
malabsorption
Clue to diarrhea 2/2 tube feedings
high osmolarity feedings
Parenteral nutrition can be stopped when enteral caloric intake reaches _____
66% of PN
KCal need/ lb
9.6 kcal/lb
Cause of bleeding in patient receiving abx
vitamin K deficiency
Greatest infectious risk assc with transfusion
Hep B
Best treatment for bleeding in von Willenbrand disease
cryoprecipitate
VIII, vWF, XIII
OTC supplement that causes increased bleeding
garlic
Bleeding + severe muscle cramps EKG changes
Prolonged QT interval 2/2 ST segment elongation
Cause of clotting in protein C mutation
factor V neutralization impaired
How to assess bleeding in LMWH patients
anti-Xa activity
Cause of bleeding in recovery room
inadequate surgical hemostasis in operation
Massive trauma how to maximize blood transfusion
red cells: FFP: platelets 1:1:1
lactic acid measurement is a marker of
response to circulatory resuscitation
Cause of hypotension in severe pancreatitis
poor venous return
Pancreatitis best resuscitation
3L isotonic crystalloid
Severe gallstone induced pancreatitis/ pulse 120- hemodynamic state
hyperdynamic perfusion
Hemorrhage following MVC –> principal cause of hypotension
venous return
Perforated diverticulitis –> hemodynamic state
hypovolemic hypoperfusion
Shock w/ gallop + distented neck veins –> cause
decreased cardiac contractility
Cause of increased hgb in respiratory failure
interstitial fluid accumulation
Hyperglycemia increases risk of
infectious complications
What helps prevent ventilator assc PNA
elevate head of bed
Hemorrhagic shock reason for urgent dialysis
hyperkalemia
most common cause of death in acetaminophen OD
cerebral edema
Alternative treatment in case of HIIT
switch to argatroban
respiratory failure ventilator mode that assumes most work of breathing
assist control ventilation
ARF what improves oxygenation
high PEEP
Pt who takes steroids develops interoperative hypoTN best step
administer hydrocortisone
Mechanism of poor wound healing with Zn deficiency
decreased fibroblast proliferation, collagen synthesis/ overally wound strength
How to reduce bacterial load in decubitus
debride
Nodule at incision site likely =
suture granuloma
wound two weeks out is mostly made of
collagen, scare inflammatory cells
Phases of wound healing
1st week is inflammatory with PMNs –> macs
1 weeks- month: proliferative (collagen)
2 maturation/ remodeling
Thickening and overturning of wound edge requires
wound edge biopsy
What should be supplemented before surgery in person with limited diet
vitamin C
Safest amount of lidocaine 1% 60kg
0.5 ml/kg
so 30 mL
Typical post op abx in uncomplicated surgery
none neeed
Scars that extend beyond the confines of original incision are
keloids
Open AAA repair requires
px abx
Initial management C diff
oral vanco
When is IV px abx administered
1 hr before sx
decreased hearing with abx use suspect what abx
vanco
Purulent drainage from old IV site next step in management
excision of IV site
What assesses acceptability for organ donation
latent HTLV/ NAT confirms
Best management for SBP following tap
IV abx in hospital
Subhepatic abscess management
imaged guided perc drainage
Most likely source of e coli sepsis
UTI
deep rusty puncture wound management
0.5 mL tetanus toxin
DIP swelling infection management
excision of the overlying nail plate
weakness both arms following trauma dx
central cord syndrome
Blunt abdominal trauma + pain + negative FAST + stable –> next step
CT scan
Convex collection of blood in head =
epidural hematoma
Tensely swollen calf management
operative fasciotomy
Acidosis + tensely distended abdomen =
ACS
painful stimuli
decorticate posturing
moans
GCS
7
Gun shot wound to a kids belly –> diffusely tender next step
ex lap
Neck stab 2 cm below mandible next step
emergent neck exploration
Parasternal stab wound –> during fast undetectable BP next step
left thoracotomy and cardiac repair
Class III hemorrhagic shock urine output
5-15 cc
1 is above 30
2 is 20-30
goal of burn rehab
prevent scar contractures and immobility
best choice for preventing burn wound sepsis
excision and grafting within 5-7 days of injury
Carbonaceous debris in nose and mouth + stridor following burn next step
intubate
Appropriate steps in management of severe burns
- secure airway, get IVs
- CT scan head and abdomen
- Calculate TBSA and start condense formula
- silvadine
TBSA answer on this test
45%
Which burns are least painful
third degree full thickness
hands in this question
Best pain management for lots of 2nd degree burns
IV narcots –> narcoids –> NSAIDs
No pulse in burnt extremity management
lateral and medial escharotomies
