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Medical Knowledge Flashcards

1
Q

most common agents for immediate hypersensitivity reaction?

A
  1. neuromuscular blocking agent > latex > antibiotics
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2
Q

max lidocaine dose? w/ or w/o epi? most common side effect of toxicity

A

7 mg/kg with epi, 5 mg/kg without epi, toxicity - light headedness, parasthesias, tinnitus, blurred vision; can progress to lethargy, tremors, seizures, arrest – tx w/ intralipids

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3
Q

goals of anesthesia in a pt w/ aortic stenosis

A

avoid hypotension, ensure adequate LV end diastolic volume, and maintenence of normal sinus rhythm

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4
Q

effects of dopamine based on dose?

A

low dose (1-2 mcg/kg/min) dopamineric -> renal/visceral vasodilation; medium dose (3-10 mcg/kg/min) beta1 adrenergic dominant, similar to dobutamine; large dose (>10 mcg/kg/min) alpha1 predominant, perpiheral vasoconstriction similar to phenylephrine

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5
Q

respiratory depression after interscalene nerve block

A

diaphragm paralysis (C3-C5 nerve roots close proximity to target areas of the block – C5-T1)

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6
Q

what anesthestic drug is contraindicated in burns

A

succinylcholine - causes rapid increase in intravascular K+

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7
Q

main side effect of barbituate toxicity

A

myocardial depression

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8
Q

cyanosis while 100% pulse ox

A

methemoglobinemia - treat with IV methylene blue

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9
Q

how to confirm ET tube placement (after ET CO2 was abnormally low in a trauma pt getting active CPR)

A

transtracheal ultrasound

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10
Q

what differentiates mallampampti class 2 and 3?

A

class 2 = uvula is only partially seen (as opposed to clase 1 where fully seen); class 3 only can see the soft and hard palate

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11
Q

describe rapid sequence intubation

A

preoxygenate, etomidate, succinylcholine, intubate

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12
Q

depolarizing muscle relaxant

A

succinylcholine

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13
Q

neuromuscular agent that undergoes hoffman degradation

A

cisatracurium

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14
Q

metabolism of rocuronium? pancuronium?

A

rocuronium is liver (like a Rock), pancuronium is renal (P for Pee)

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15
Q

hyponatremia, elevated urinary sodium, hypovolemic

A

cerebral salt wasting - sudden increased uop, lose volume and sodium

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16
Q

hyponatremia, elevated urinary sodium, euvolemia/hypervolemia

A

SIADH; tx w/ NS (fluid restriction could worsen cerebral ischemia in brain pts), adjuncts include demeclocycline and vaptans

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17
Q

physiologic changes in pregnancy

A

decreased pCO2, respiratory alkalosis; unchanged vital capacity, increased blood volume, dilutional anemia, right shift hemoglobin curve, increased circulating WBCs

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18
Q

central vs nephrogenic di

A

central DI = lack of ADH, nephrogenic DI = diminished renal response to DI – in central DI, administration of desmopresson will allow kidney to concentrate urine

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19
Q

initial management of hepatorenal syndrome

A

cessation of diuretics, albumin bolus – if doesnt work, may need pressors, midodrine/octreotide, liver txp

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20
Q

metabolic abnormalities in a pt w/ high EC fistula output from small bowel

A

hypokalemic, hyponatremic w/ metabolic ACIDosis (lose bicarb through small bowel)

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21
Q

central pontine myelinosis - caused by, how to counteract

A

due to rapid correction of hyponatremia (brain cells with low solutes - water goes into blood, shrinks the cells) can counteract with desmopressin/ADH because ADH helps retain water and prevent rapid autocorrection of sodium

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22
Q

anion gap formula

A

sodium - chloride - bicarb = anion gap; normal is 8-16

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23
Q

indication for urgent treatment of hyperkalemia

A

> 6.5, or ECG changes, or rhabdomyolysis

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24
Q

p53 effect on apoptosis

A

p53 Promotes apoptosis (as opposed to BCL2 - which inhibits)

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25
Q

spontaneous regression of malignant tumors occurs in….

A

melanoma, testicular germ cell tumors and neuroblastomas

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26
Q

cyclosporine - mechanism, adverse effects, metabolism

A

inhibits synthesis of IL2, IL4, nephrotoxic, gingival hyperplasia, hirsutism, thrombocytopenia; undergoes hepatic metabolism

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27
Q

example of type 1-4 hypersensitivity reaction; what cells mediate them

A

type 1 HSR - IgE / eosinophils, bee stings, allergens; type 2 HSR IgG/IgM mediated with complement activation - ABO incompatability, type 3 HSR immune complex mediated response SLE, serum sickness, RA; type 4 T cell mediated, delayed reaction, tuberculosis skin test / contact dermatitis

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28
Q

larget producers of TNF alpha and IL1

A

macrophages

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29
Q

IL2 is primary produced by…

A

T cells

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30
Q

IL10 functions to…

A

largest inhibitor of inflammatory response, macrophages

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31
Q

management of lung abscess

A

antibiotics first – should also consider bronchoscopy in pt w/ risk factors for lung ca to rule out malignancy – large abscesses or fail to respond to therapy need surgery lobectomy/pneumonectomy – perc drains considered in poor surgical candidates

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32
Q

mechanism of piperacillin-tazobactam

A

piperacillin is a beta lactam inhibitor, final step of bacteral cell wall synthesis; tazobactam binds beta lactamases

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33
Q

mechanism of metronidazole

A

inhibits nucleic acid synthesis, effective vs anaerobes

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34
Q

30S ribosome inhibitors

A

aminogyclosides, tetracycline

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35
Q

50S ribosome inhibitors

A

macrolides, linezolid, chloramphenicol

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36
Q

mechanism of clindamycin

A

lincosamide antibiotic, interferes with amino acyl-tRNA complex

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37
Q

what is qSOFA score

A

RR > 22, altered mental status, SBP <100 – if 2/3, further workup treatment of sepsis indicated

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38
Q

new definition of septic shock

A

sepsis that requires vasopressors to keep MAP >65 and lactate level greater than 2

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39
Q

management of perianal abscess in HIV+ pt – nuances

A

I&D, +/- seton, need biopsy because abscess may be presenting symptom of anal/rectal malignancy, antibiotics are routine given immunocompormised setting

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40
Q

soft tissue mass within a lung cavity that is surrounded by a crescent of air

A

aspergilloma

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41
Q

post exposure prophylaxis for anthrax

A

ciprofloxacin or doxycycline – treatment of fulminant dz is cipro/clinda/rifampin

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42
Q

most common organism cause of acute mesenteric lymphadenitis

A

yersinia enterocolitica

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43
Q

organism causes of toxic shock syndrome

A

s. aureus&raquo_space;> s. pyogenes (group A strep)

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44
Q

clostridium septicum infection is associated with..

A

colonic and hematologic malignancies

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45
Q

gentamicin is effective against which organisms?

A

gram negative rods – specifically enterococcus and serratia – has poor activity against strep, no activity vs anaerobes, assoc w/ nephrotoxicity and CN8 toxicitiy; very low therapeutic index

46
Q

prolonged use of this antibiotic is associated with peripheral neuropathy

A

metronidazole

47
Q

first sign of tetanus

A

trismus

48
Q

exotoxins are produced by…? endotoxins?

A

exotoxins are produced by gram+ organisms, endotoxins are produced by gram- organisms

49
Q

respiratory quotient >1, =1.0, =0.8, =0.7

A

RQ is ratio of CO2 produced to O2 consumed – estimate what energy source is primary substrate for energy production – if >1, suggests lipogenesis (overfed state), if =1 carbs, 0.8 = protein, 0.7 = fats – starving patients have RQ < 0.7

50
Q

protein requirement in… adult? burn pt? preterm infant?

A

adult = 0.8 g/kg/d, burn 2-2.5 g/kg/d, preterm 3-4 g/kg/d

51
Q

gold standard of nutrition assessment in trauma pt

A

nitrogen balance

52
Q

which patients need tapering of tpn prior to cessation

A

diabetics pt, poor glucose control (otherwise its unnecessary)

53
Q

what does the body use after glycogen stores are depleted

A

breakdown of skeletal muscle and lipids – amino acids used for gluconeogenesis in liver (early), kidney (late)

54
Q

what are the non-essential amino acids

A

alanine, aspartic acid, asparagine, glutamic acid, serine

55
Q

what are the essential amino acids

A

phenylalanine, threonine, tryptophan, methionine, lysine, histidine – all branched chain amino acids (leucine, isoleucine, valine) are essential amino acids – conditionally essential ones are arginine, cysteine, glycine, glutamine, proline, tyrosine

56
Q

most important amino acid used for gluconeogenesis by the liver? kidney?

A

liver: alanine, kidney: glutamine

57
Q

cachexia is most associated with which type of cancer

A

pancreatic cancer, assoc with increased TNF alpha and PIF (proteolysis inducing factor)

58
Q

chromium deficiency

A

diabetes, peripheral neuropathy, encephalopathy

59
Q

zinc deficiency

A

alopecia, poor wound healing, immunosuppression, night blindness, skin stuff

60
Q

copper deficiency

A

microcytic anemia, pancytopenia, depigmentation, osteopenia

61
Q

molybdenum deficiency

A

toxic accumulation of sulfur containing amino acids, encephlopathy

62
Q

selenium deficiency

A

skeletal and cardiac myopathy

63
Q

nutritional basis of TPN? PPN? how to help improve hepatic steatosis with TPN

A

glucose for TPN, fat for PPN – carnitine supplementation for hepatic steatosis (does not reverse liver dmg)

64
Q

chemotherapy approved for HCC

A

sorafenib

65
Q

how does UV radiation cause cancer

A

initiator and promoter of direct DNA damage and damage of DNA repair mechanisms – UVB most significant contributor to skin dmg, more melanin is protective, mutation in ras/p53 occur early in skin cancers

66
Q

how does radiation work to kill cancer

A

leads to increased free radicals which disrupt DNA (double strand DNA breaks), as energy increases, skin is more spared; tissue hypoxia shown to significantly reduce radiation damage (patient modifiable factor) – M phase most vulnerable stage of radiation therapy

67
Q

methotrexate toxicity - dx / tx

A

elevated liver transaminases, reduced gfr, leukopenia, thrombocytopenia – tx w/ leucovorin (folinic acid)

68
Q

most common metastasis to adrenal gland

A

from lung

69
Q

most common metastasis from breast ca

A

to brain

70
Q

most common metastatic tumor from melanoma

A

to lung (and also small bowel)

71
Q

p53

A

chromosome 17p13.1, promotes apoptosis, tumor suppressor gene, mutation leads to unregulated cell growth (Li Fraumeni), HPV encodes protein E6 which binds/inactivates p53

72
Q

most devastating complication on bevacizumab (avastin)

A

spontaneous bowel perforation

73
Q

treatment of gastric MALT lymphomaj

A

eradicate H. pylori. reserve chemo/rads for pts who do not respond, have recurrence, or have mets at time of dx. however pt w/ complete GOO or uncontrollable bleeding need gastrectomy

74
Q

which patients benefit from anti-EGFR monoclonal antibodies

A

those with K-ras wildtype gene (K-ras negative)

75
Q

indication for brca testing

A

breast ca <50, cancer both breasts, both breast/ovarian ca in same family, male breast ca, ashkenazi Jewish descent

76
Q

paralytic agent of choice for patient with underlying cirrhosis/liver dz

A

cisatracurium or atracurium – metabolized by Hoffman degradation (bypassing liver)

77
Q

effect of bicarb in metabolic acidosis

A

raises pH at cost of hypernatremia, hypokalemia, and left shift of oxyhemoglobin curve (can worsen tissue hypoxia)

78
Q

which medications make it so you need higher doses of warfarin?

A

CYP450 inducers (increases metabolism of warfarin) barbituates, phenytoin, prednisone, rifampin, omeprazole

79
Q

which medications make it so you need smaller doses of warfarin?

A

CYP450 inhibitors (decreases metabolism of warfarin) amlodipine, cimetidine, cipro, cyclosporine, diltiazem, ketoconazole, isoniazid, propanolol

80
Q

mechanism of digoxin

A

inhibits Na/K ATPase in myocardium, leads to increased intracellular sodium, and thus intracellular calcium, leading to stronger cardiac contraction – acts on AV node, shortens QT interval, toxicity worsened in hypokalemic pt

81
Q

mechanism of 5-FU

A

thymidylate synthase inhibitor that inhibits purine and DNA synthesis

82
Q

mechanism of cyclosporine

A

binds cyclophilin proteins and inhibits cytokine synthesis (IL2)

83
Q

mechanism of vincristine

A

inhibits microtubule formation

84
Q

mechanism of taxol

A

microtubule formation and stabilization

85
Q

mechanism of infliximab

A

monoclonal antibody against TNF alpha - inhibits ability of TNF alpha to bind to receptors and reduce autoimmune inflammatory response

86
Q

mechanism of bevacizumab

A

VEGF inhibitor, improve survival in pt with metastatic CRC

87
Q

how to reverse warfarin – active bleeding? within 1 day? within 1 week?

A

PCC, oral vitamin K, autocorrection

88
Q

antidote for cyanide poisoning

A

inhaled amyl nitrite followed by IV sodium nitrite, sodium thiosulfate converts cyanomethemoglobin to thiocyanate (metabolite that is excreted in urine)

89
Q

antidote for methemoglobinemia

A

methylene blue

90
Q

side effects: hypocalcemia, hypokalemia, gout, ototoxicity, tinnitus

A

furosemide

91
Q

side effects: intractable nausea/emesis, particularly with EtOH

A

metronidazole

92
Q

side effects: hyperkalemia and gynecomastia

A

spironolactone

93
Q

side effects: fulminant hepatic failure

A

halothane

94
Q

side effects: vasodilation resulting in cutaneous flushing

A

vancomycin - red man syndrome

95
Q

differential diagnosis for sudden drop in end tidal CO2 in OR?

A

obstructed airway, accidental extubation, disconnection of the circuit, cardiac arrest, and pulmonary embolism

96
Q

post op w/ pain and tenderness over angle of jaw with fevers and leukocytosis

A

postop parotitis - leads to decrease saliva production, tx broad spectrum antibiotics (staph coverage), warm compresses

97
Q

most important predictor of colonic ischemia following AAA repair

A

prolonged hypotension pre-op&raquo_space;> ligation of patent IMA

98
Q

strongest predictor of pulmonary related post op complications

A

preop serum albumin

99
Q

management of venous thrombus associated with PICC

A

if evidence of DVT, determine if line is still needed or not, if still needed, keep line and start anticoag for 3-6 months, if line is infected/anticoag is contraindicated, can remove line, but wait 5-7 days after initiation of heparin before removing it

100
Q

most common cause of death from blood transfusion

A

acute lung injury > ABO incompatability > bacteral contamination

101
Q

decreased fibrinogen, prolonged thrombin time, normal platelets

A

primary fibrinolysis (decreased platelets in DIC)

102
Q

mechanism of plavix

A

indirectly inhibits activation of glycoprotein 2b/3a receptors on platelet surface (functionally similar to Glanzmann’s thrombocytopenia)

103
Q

cryoprecipitate contains…

A

fibrinogen, factor 8, factor 9, vWF, fibronectin

104
Q

how to prevent febrile nonhemolytic transfusion reaction

A

WBC filtration > washing

105
Q

how to counter harmful effects of steroids/radiation on wound healing

A

vitamin A

106
Q

describe the phases of wound healing

A

phase 1 - hemostasis/inflammation, neutrophils -> macrophages phase 2 - proliferation, fibroblasts 4+ days phase 3 - maturation - type 3 collagen replaced w/ type 1, angiogenesis 3-4 weeks

107
Q

essential fatty acid vs zinc deficiency

A

delayed wound healing, increased infection, diarrhea and rash – EFA rash tend to be more scaly/ assoc. w/ dry skin; zinc primary located in perioral areas and inteartriginous skin of finger/toes

108
Q

type 1 collagen deficiency

A

osteogenesis imperfecta

109
Q

type 4 collagen deficiency

A

alport/goodpasture syndrome (basement membrane)

110
Q

type 5 collagen deficiency

A

classic form of ehler’s danlos

111
Q

most important layer of small bowel for tensile strength?

A

submucosa

112
Q

most important layer of esophagus for tensile strength

A

mucosa (thicker squamous epithelium, vs. submucosa)

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