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Written Boards - Final > Medical Knoweledge > Flashcards

Medical Knoweledge Flashcards

1
Q

largest water space in body?
smallest?

A

intracellular 40%

intravascular

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2
Q

What recylces interstiital cluid and where does it end up?

A

lymph, vasc

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3
Q

intra v extra predom K vs alb

A

K intra
alb extra

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4
Q

intracellular cations and anions

extra?

A

K and mg; protein and phos

na; Cl and bicarb

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5
Q

intavascular overall cation concentration is higher due to

A

high protein anions

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6
Q

blood transfusion effect on intravasc osm pressure

A

decrease as water is pushed out by large particle

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7
Q

4-2-1 rule?

A

1ml/kg first 20 K
2 10K
4 10K

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8
Q

components of NS and LR

A
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9
Q

definition of oliguria in 70 kg man

A

Oliguria in a 70-kg man is defined by less than 400 mL of urine produced and excreted in a 24-hour period.

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10
Q

For icu patients what would we prefer hyper vol or hypo and why?

A

hyper

pulm failure carries 25% mortality while kidney failure 48%

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11
Q

signs of high IV fluid status

A

High output generally will mean that the body is trying to rid itself of water; surgeons should assist it by decreasing the maintenance fluid rate. Anasarca is another helpful clue, as are the customary vital signs.

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12
Q

How does Pto F ratio help with determining fluid status

A

poor ratio equals fluid in inteerstitium

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13
Q

usual reason for post op low uopin surg patients

A

In most, if not all such patients, low urine output postoperatively means that they have deceased renal blood flow from insufficient intravascular volume.

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14
Q

stress dose regimen for adrenal insufficiency

A

50 mg hydrocortisone q8h

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15
Q

severe hyponatremia s/s

mech

A

Severe hyponatremia, however, can cause headaches and lethargy; patients can even become comatose or have seizures.

brain cell swelling

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16
Q

3 broad causes of hyponetremia

A

iatrogenic
brain
lung

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17
Q

bodys normal initial response to hyponatremia?

What volume status is this hindered by

A

adh suppression

hypovol state causes pituitary to secrete adh

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18
Q

adh secreting tumors

A

small cell lung and carcinoid

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19
Q

the 3 volume states of hypernatremia and teh causes

A

Hypovolemic hypernatremia commonly occurs in dehydrated patients with low water intake, high fluid losses such as vomiting, nasogastric tube loss, or diarrhea. Euvolemic hypernatremia is seen in patients with DI (nephrogenic or neurogenic) because of excess loss of urinary free water. Hypervolemic hypernatremia is usually iatrogenic caused by resuscitation with hypertonic solutions or a result of excess mineralocorticoids in Conn or Cushing syndrome.

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20
Q

what controls potassium excretion

A

RAAS aldosterone

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21
Q

consequences at differing levels of hypokalemia

A

ve a [K+] lower than 3.5 mmol/L. Hypokalemia is commonly a result of hyperpolarization of the resting potential of the cell. Hyperpolarization interferes with neuromuscular function. Hypokalemia is associated with generalized fatigue and weakness, ileus, atrial arrhythmia, and acute renal insufficiency. On occasion, rhabdomyolysis occurs in patients whose [K+] drops below 2.5 mmol/L. Flaccid paralysis with respiratory compromise can occur as [K+] decreases to less than 2 mmol/L.

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22
Q

2 electrolyte associations with hypok

A

hypo mg and acidemia

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23
Q

ekg changes with hypo K

arrythmias?

A

depressed T and U waves

atrial tach, v tach, v fib

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24
Q

why is hypokalemia so stubborn

A

severe intracellular depletion is needed to show up in serum

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25
Q

why is mg needed for hypok repletion

A

intracellular co-cation for transport, reduces arrythmia risk

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26
Q

primary clinical problem with hyperK

what is a dangerous level?

usual cause in the hospital

A

arrythmias – peaked T waves

6-7

renal failure

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27
Q

what is recommended prior to reperfusion of ischemic limb from an elevtrolyte standpoint

A

bicarb for K

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28
Q

first thing to give for hyperK

mech?

A

Ca

antagonizes depolarizing effect of K

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29
Q

acidotic hyperK treatment?

A

bicarb, H out – K in

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30
Q

mainstay of hyperK tx after Ca

A

insulin and gluc — pushes K into cells via na K ATPase

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31
Q

pending arrest hyperK treatment

A

Loss of P wave and broad slurring of QRS; immediate effective therapy indicated
Intravenous (IV) infusion of calcium salts
10 mL of 10% calcium chloride during a 10-minute period or 10 mL of 10% calcium gluconate during a 3- to 5-minute period
IV infusion of sodium bicarbonate
50-100 mEq during a 10- to 20-minute period; benefit proportional to extent of pretherapy acidemia

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32
Q

hypoalbumenia does what to calcium in serum

A

decreases by 0.8 per 1 drop

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33
Q

what can happen to calcium during blood transfusion for trauma

A

can drop due to citrate load

always give calcium!

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33
Q

3 situations with hyperphosphatemia

A

uch as those with tumor lysis syndrome, rhabdomyolysis, or chronic renal failure

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34
Q

what coexisting deficiency needs to be fixed to tx hypocalcemia

A

hypomg

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35
Q

3 tx for hyperphos if renal function impaired

why is this important when trying to fix hyper ca

A

saline
acetazolimede
hemodialysis

phos dec PTH stim and binds to ca in serum

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36
Q

treatment for chronic hypocalcemia

A

oral supplement , maybe vit D

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37
Q

tx for hypercalciuria

A

thaiazide

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38
Q

signs of severe hyper ca

A

weakness, stupor, and central nervous system dysfunction. In

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39
Q

MCC of hyperca

2 others

what about inpatient vs gen pop

A

primary hypePTH

malignancy and unregulated PTH

It occurs most commonly with malignant diseases in hospitalized patients and with hyperparathyroidism in the general population.

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40
Q

MC malignant cause of hypercalcemia

A

breast ca

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41
Q

hypercalcemia s/s

A
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42
Q

What is secondary hyperPTH

A

renal disease — remove glands

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43
Q

What is the mechanism of hypercalcemia of malignancy

A

pTHrp but sometimes actual PTH elevation

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44
Q

causes of hypocalcemia

A

e hypoparathyroidism after thyroid or parathyroid surgery, vitamin D deficiency, gastric bypass, acute pancreatitis, osteoblastic metastases, massive transfusion, and hyperphosphatemia.

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45
Q

perioral numbness specific for what electrolyte abnorm

A

hypoca

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46
Q

ekg change with hyperca

A

short QT

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47
Q

Long term symptoms of hyperca

A

nephrolithiasis, renal tubular acidosis, and renal insufficiency

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48
Q

hypoca ekg finding

A

long qt

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49
Q

hyperca treatment

A

Treatment of hypercalcemia is initially begun with intravenous saline hydration.
Loop diuretics (after normalization of volume status), calcitonin, intravenous bisphosphonates, and glucocorticoids can also be used in severe hypercalcemia.

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50
Q

electrolyte abnormality post liver resection

A

Significant hypophosphatemia is common following major liver resection, an effect caused by rapid phosphate utilization in the regenerating hepatocytes.

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51
Q

severe hypomg arryhtmia

A

torsades

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52
Q
A
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53
Q

First cells to arrive after platelet activation

A

neutrophils last for 48h

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54
Q

Mp timing in wound healing. Job?

A

48-96
debris, bacteria, signal fibroblasts

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55
Q

Proliferation phase is characterized by these two cells

What type of collagen is present and what is happening to it

what aids in this

A

fibroblasts and myo fibroblasts

3, crosslinking

VC

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56
Q

when does remodeling start? Collagen make up? orchestrating cell?

A

3weeks
3—>1
Mps

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57
Q

Vitamin A in wound healing?

zn deficiency issue?

A

may reverse poor healing from steroids

poor epithelialization

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58
Q

how long until epithelialization occurs in wound healing?

A

48h

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59
Q

What is usually the cause of leg ulcers

A

venous insufficiency

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60
Q

time limits on wound closures leg vs face

A

18
24

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61
Q

irradiated wounds can be treated with 2 interventions

A

hyperbaric and flaps

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62
Q

term for cappilary formation in STSG

A

inoscultation

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63
Q

What needs to be held prior to surgery med wise?

7 days

5 days

48h

24h

A

Plavix, ticagrelor

warfarin

NOACs

ACE, ARB, heavy diuretics

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64
Q

first cell to arrive on wound scene

what is release by endothelial cells that recruits leukocytes

A

nps

NO

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65
Q

inr response to injury
tnfa
IL6
IL10

A

act pro inflam path
Acute phase reactant
anti inflam

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66
Q

post transplant prophylaxis? duration?

A

gangciclovir and bactrim for 3 - 6 months

clotrimazole for mucocut candi

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67
Q

2 most common bugs for postransplant diarrheal illness

A

cdiff and cmv

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68
Q

what other body system needs annual check post transplatn

A

skin

69
Q

induction therapy focuses on preventing this cell signaling

mainstayt of kidney induction

A

T cell

antithymocyte globulin

70
Q

2 big SE for antithymocyte glbulin

what cell is targeted

A

pancytopenia and virus reactivation

T cell

71
Q

what are the calcineurin inhibitors?

main SE

A

Tac and cyclosporine

nephro, HUS(cyclo)

72
Q

long term steroid choice for transplant

A

prednisone

73
Q

immune action of steroids

A

inhibits nfkb, inhib cytokines and lymph prolif

74
Q

azathiprine 3 big SE

A

pancytopenia, BLACK BOX, pancreatitis

75
Q
A
76
Q

what are the 2 transplant antimetabolites

A

mycophenelate and azothioprine

77
Q

sirolimus and everolimus mech

never use with what other transplant med

A

mTOR interferes with IL2

black box with CNI, graft loss and mortality nc

78
Q

next 2 steps when concerned about liver or kidney rejection

A

u/s and bx

79
Q

hyperacute rejection timing and cause

A

24h

ABO incomp—needs crossmatch

80
Q

acute rejection timing

what type shows lymphocyte infiltr and necrosis? TX? refractory?

what if bx shows vasculitis

A

24h-3m

cell mediated type4 hyper sens
steroids
antithymocyte

ab mediated

81
Q

chronic rejection timing

path?

A

m to y

interst fibrosis ischemic atrophy, arteriosclerosis

82
Q

chronic lung rejection presentation

A

bronch obliterans

83
Q

MC post transplant window for infeciton

A

1-6m

84
Q

4 big opportunistic infections in acute phase

A

CMV
BK
PCP
mucocut candida

85
Q

What does BK effect in transplant

tx

A

uret stenosis, nephritis–>70% fail

red immunosupression

86
Q

Tx for post transplant lymphoproliferative disorder

A

red immunosuppression

87
Q

SSI duration coverage for classification

A

30 days

88
Q

AIDs is defined as

A

HIV with 200 CD4 cells or AIDs defining illness

89
Q

What to do with periop managment of HIV drugs

A

continue, a couple of days is fine though

90
Q

storage life of rbcs

whole blood?

A

42 days

4 weeks

91
Q

what is the exception for the hb transfusion threshold

A

MI

92
Q

fridge time for ffp

A

5d

93
Q

how are cryo and FFP related

A

cry is made up of fibronectin, factor 8 factor 13, vwf, and fibrinogen

these precipitate out after FFP is thawed

94
Q

thresholds for certain procedures for platelet count

A
95
Q

2 instances of cryoprecipitate use

A

trauma and DIC(100K)

96
Q

what do I always forget to give with mass transfusion how often should it be given

A

Ca every 3-4 units

97
Q

tx for severe transfusion reaction

A

stop
steroids
epi
saline
diuretics

98
Q

bilious vomiting in infant is _____ until proven otherwise.

Imaging?

A

mid gut volvulus

upper gi only if stable

99
Q

redness at gastric band port site means….

dg modality?

A

band erosion

scope

100
Q

inguinal triangles and borders

A
101
Q

MC benign liver tumor

2 primary complications

2 secondary

A

hemangioma

kasabach merrit and bleeding

GOO and budd chiari

102
Q

when can triple neurectomy be used for mesh pain

A

when neuropathic s/s are present

103
Q

plastic stent overall treatment duration for biliary stricture post injury

replacement sched?

A

1 year

3-6m

104
Q

splenectmoy vax sched

whats the diff between pneumoc 13 and 23 — when is each given

A

number of strains covered

13 initial then 23 2 months later, q 5y 23 admin

105
Q

obturator hernia treatment algorithm

A
106
Q

obturator hernia repair anatomy

A
107
Q

desmoid unresectable treatmetn

mech?

A

sorafenib

TKI

108
Q

comorbidity reduction in young vs old bariatric patients

A

greater improvement

109
Q

for large condyloma lesions, what is the preferred intervention

what limits this

A

excision

sphincter involvement

110
Q

another name for microsatellite stable

unstable?

how does this change managment for stage 2 colon cancer

A

proficient MMR

deficient MMR

if dMMR or high micro instability then patient needs adjuvant

111
Q

common cause of PPI failure

what cells are affected

A

skipping doses and not taking with food causing rebound reflux
parietal

112
Q

new treatment for uncomplicated, no abscess diverticulitis

A

out[atient obs

113
Q

SB adenoca risk with common assoc syndromes or diseases

A
114
Q

ultrasound benefit for breast ca

A

better detection of invasive node neg ca

115
Q

risk increase or dec for breast ca:
breast feeding
older at preg
post partum

A

dec
inc
inc

116
Q

first step for trouble shooting poor radiotracer uptake in axilla

A

The most common cause of failure of radioactive tracer to map to the axilla is injection into the breast parenchyma alone. For this reason, it is recommended to inject the radioactive tracer into the dermal plane. Injecting fluid in the site of the radioactive tracer injection site increases the interstitial pressures and forces more radioactive tracer into the lymphatic channels. Sterile saline or local anesthetic can be used with volumes of 10 to 40 mL.

117
Q

benefit of neoadj for breast ca

A

inc eligibility for breast conservation

118
Q

ATM gene cancers

A

panc and rbeast

119
Q

managment of ANY met disease in SLNB following neoadjuvant treatmetn

A

ax dissection

120
Q

mucinous ca of breast:
prognosis?
receptors?
who gets it?

A

good
estrogen
menopausal

121
Q

2 breast density categories with inc cancer risk

A

C and D
50-75% dense, 75 up

122
Q

bariatric weight cutoffs

A

35 no com
40 comorb

123
Q

6 characteristics of malnutrition

A

Decreased energy intake
Weight loss
Body fat loss
Muscle mass loss
Edema
Reduced grip strength

124
Q

what happens to albumin during inflammation

A

drops due to catabolism for cysteine

125
Q

what helps in confirming reliability of our three nutritional acte phase reactants

A

CRP

for transferrin, albumin and prealbumin

126
Q

calorie needs per patient state? protein?

A

normal - 30 - 1
stressed - 35 - 1.5
burns - 40 - 2+

127
Q

protein glucose and fat kcal per

A

4, 4, 9

128
Q

RQ qotients for fat, protein carbs

A

0.7
0.8
1

129
Q

nitrogen balance equation

A
130
Q

4 supplements cirrhotics might need for their nutrition

A

phosphate, zn, multi, B1 thiamine

131
Q

cholestasis nutritional restriction strategy

A

manganese and cu

132
Q

4 results of hyper proteinemia

A

hyperammonemia, met acidosis, dehydration, azotemia

133
Q

high gastric output mineral deficiencies

A

mag, ca, B12, iron

134
Q

bariatric surgery mineral deficiencies

A

Thiamine, fe, cu, zn, se, thiamine, folate, VB12, VD

135
Q

better tube feeding strategy for diabetics

A

bolus

136
Q

Main benefit of EN in critical illness

timing for tbi ? general?

specific effect on burn patients

A

improved immune health, improved outcomes

48 h; 24-48

less ileus

137
Q

what is osmotic diarrhea caused by with EN

A

sorbitol

138
Q

arginine in critical care nutrition

A

Trauma and sepsis deficient
GH
T cells
AA synth

139
Q

omega 3s in icu nutrition

A

eicosanoids such as prostaglandins, thromboxanes, and leukotrienes via oxygenation and lipoxygenase enzymes from the n-6 arachidonic acid metabolic pathway, producing less reactive molecules

140
Q

EN modulated Ig

A

IGA

141
Q

Major metabolic fuel of enterocytes, colonocytes and immune cells

A

Glutamine

142
Q

preferred tube feed composition with respiratory failure patients

A

high fat low carb for RQ

143
Q

tube feed composition for renal patients

A

low protein, K , Ph

144
Q

GS for determining resting energy needs

A

indirect caloriemtry

145
Q

3 electrolyte deficiencies with refeeding

A

ph, mg, k

146
Q

equation for obese ICU patients

obese floor

2 others

A

Penn state

mifflin

harris benedict and ireton jones

147
Q

pneumoperitoneum effect on lungs

what is increased by anethesia to deal with the CO2

A

Decreased functional residual capacity, increased peak airway pressures, and reduced pulmonary compliance, because increased abdominal pressure pushes the diaphragm cephalad

inc mV

148
Q

renal effects from pneumoperitoneum

A

oliguria

149
Q

unexplained hypercarbia during case may be due to …

A

gas extrav

150
Q

coag v cut energy

A

high f variable

continuous low

151
Q

ultrasoinc sealing vessel size currently

A

3mm

152
Q

hot snare polyp size for colonoscopy

A

10mm

153
Q

define type 1 and 2 errors

A
154
Q

what does HER2 code for

A

epidermal growth factor

155
Q

bevacisumab target and cancer type

A

VEGF; colon ca

156
Q

imatinib and sunitinib mechs

A

TKIs

157
Q

indications for breast radiation following mastectomy

A

r large tumors (> 5 cm or T3/T4 tumors, one or more positive lymph nodes, positive margins, and inflammatory breast cancer)

158
Q

indicatoins for adjuvant chemo in breast ca

A

ER-negative tumors greater than 1 cm, ER-positive tumors greater than 1 cm with high Oncotype scores, HER2-positive tumors, and lymph node–positive disease.

159
Q

3 candidates for non breast cancer endocrine therapy

A

atypical ductal hyperplasia, atypical lobular hyperplasia, and lobular carcinoma in situ.

160
Q

when does sarcoma get adj chemo ? rad?

A

high grade

pos margins

161
Q

3 indications for thyroid cancer adjuvant? What is it

A

tumors greater than 4 cm, extrathyroidal extension, and regional lymph node metastases.

RAI

162
Q

what is oncotype DX used for

A

ER positive risk strat

163
Q

who can we omit adjuvant rads on for breast cancer

A

70 years or older, with T1/T2, node-negative, and ER-positive tumors.

164
Q

what two thyroid cancers do not respond to RAI

A

medullary and anaplastic

165
Q

results of 5 years of imatinib following resection

A

improved overall survival

166
Q

rads for R1 sarcoma adjuvant benefit

A

dec recurrence

167
Q

benefit of sorafenib

A

increased overall survival in met HCC

168
Q

inguinal canal contents in women v men

A
169
Q
A

Written Boards - Final (21 decks)

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