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Misc Flashcards

1
Q

Antibiotics to treat low-risk neutropenic fever…

A

Augmentin/Cipro

If PCN allergy, use clinda/cipro

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2
Q

How do we define neutropenic fever?

A

Temp > 38.0 for > 1 hour or isolated temp > 38.3 WITH ANC <=500

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3
Q

How do we treat high-risk neutropenic fever?

A

Zosyn or cefepime
If concern for line infection, add vanco
If concern for PNA, add gent or pulmonary fluroquinolone

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4
Q

BUN: Cr in pre-renal vs ATN

A

20:1 vs <20:1

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5
Q

Urine Osm in pre-renal vs ATN

A

> 500 vs <450

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6
Q

Urine specific gravity pre-renal vs ATN

A

> 1.020 vs <1.010

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7
Q

Urine sodium pre-renal vs ATN

A

<20 vs >40

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8
Q

FeNA in pre-renal vs ATN

A

<1% vs >2%

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9
Q

Casts seen in prerenal vs ATN

A

Hyaline vs muddy brown

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10
Q

Calculate energy expenditure

A

Harris-Benedict equation:
energy need = 655 + 9.6(wgt in kg) + 1.7(hgt in cm) + 4.7(age in yrs)

For normal person, multiple by 1.3 to get energy needs for TPN

Carbs = 50-60%
Protein = 10-20%
Lipids = 20-30%
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11
Q

How to calculate FeNa

A

(Serum Cr * urine Na)/(urine Cr * serum Na)

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12
Q

Causes of non-anion gap metabolic acidosis

A

RTA
Intestinal loss of bicarbonate (diarrhea/fistula)
Dilutional acidosis (rapid infusion of bicarbonate-free isotonic saline)
Ileostomy
Ureterosigmoidostomy
Drugs

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13
Q

Treatment of malignant hyperthermia

A

Dantrolene

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14
Q

Bladder innervation

A

Superior hypogastric plexus located over the sacral promontory
Hypogastric nerves contain sympathetic fibers and run below the ureter and lateral to the uterosacral - responsible for bladder compliance, urinary continence
Parasympathetic nerves come from pelvic splanchnic nerves and form the inferior hypogastric plexus which run along the parametria - responsible for detrusor contractability and rectal function

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15
Q

Type II vs type III radical hysterectomy

A

Type II is nerve sparing thus decreasing urology morbidity —> no difference in survival

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16
Q

What to do for ureteral injury

A

Above the pelvic brim: ureteroureterostomy or tranureteroureterostomy
Near bladder: Reimplantation
If much of pelvic ureter is removed, can perform a psoas hitch
If bladder is scarred preventing mobilization, a boari flap

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17
Q

Structures passing through the fossa ovalis

A

Fossa ovalis - opening in the fascia (covered by the cribiform)
Great saphenous vein, superficial epigastric artery, superficial external pudendal artery, femoral branch of the genitofemoral nerve

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18
Q

Most common fistula after radical hysterectomy; how do we diagnose and manage?

A

Ureterovaginal - 2-3%; present with watery vaginal discharge within 14 days of surgery

Diagnose with CT urogram or give pyridium and tampon test; Treat with stent or PCN

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19
Q

What bacteria cause vaginal cuff cellulitis? How do you treat it?

A

Polymicrobial - trx empirically with broad-spectrum penicillin with b-lactamase inhibitor (augmentin) or later-generation cephalosporin

Can also use flagyl and fluoroquinolone

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20
Q

What is the size threshold for draining an infection hematoma/abscess?

A

5 cm - can treat with gent/clinda or zosyn or cipro/flagyl

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21
Q

What are the bugs that cause hospital acquired PNA? What do you treat with?

A

HAP is no longer an entity defined by the ID society - but bugs are H influenza, Strep and Staph; less commonly E. coli, Enterobacter, Klebsiella, Proteus and Serratia

Treat with augment, levaquin, second or third generation cephalosporin

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22
Q

What are most common causes of community acquired PNA? How do you treat?

A

Strep pneumo, Klebsiellsa

Treat with respiratory quinolone or augmentin PLUS macrolide or doxy

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23
Q

How should we treat aspiration PNA?

A

Zosyn OR clinda + gent or cipro OR extended-spectrum cephalosporin + flagyl

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24
Q

Which type of hysterectomy has the highest risk of GU injury?

A

Laparoscopic

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25
What to do with a ureteral crush injury...
Mild/minor - stent | Major/severe - resection of the injured portion with reanastomosis
26
Initial management of an anastomotic bowel leak...
Antibiotics and percutaneous drainage
27
What is blind loop syndrome?
Bacterial overgrowth in the small bowel —> chronic diarrhea and B12 deficiency
28
What increases risk for LE lymphedema following hysterectomy for uterine cancer?
Obesity, removal of more nodes, extent of surgery, post-operative infection, radiation therapy, postoperative DVT
29
Most common complication of a radical hysterectomy?
Bladder atony and urinary retention
30
How can we prevent wound infections in vulvar surgery?
Spare saphenous vein, optimize glucose control and use appropriate abx; we can also perform sentinel LN biopsy
31
What is incidence of lymphedema after inguinal LND? Risk factors?
``` Incidence = 14-48% RFs = obesity, # of nodes removes, extent of surgery, postoperative infection, RT to groin, postoperative DVT ```
32
Intrinsic vs extrinsic apoptosis pathway
``` Intrinsic = Mitochondrial mediated (get cytosolic cytochrome c —> activated by DNA damage, ER stress, oncogene activation; caspase 9 + cytochrome c = APAF1 Extrinsic = Death receptor mediated (TRAIL, TNFR); cascade 8 ```
33
What is apoptosis?
Programmed cell death
34
What cascade is common executioner between intrinsic and extrinsic?
Caspase 3
35
Characteristics of apoptotic cells under microscope?
Chromatin condensation, nuclear fragmentation, membrane blabbing and cell shrinkage, formation of apoptotic bodies
36
What are gamma rays?
Emitted from unstable atomic nuclei during decay of radioactive material; used in brachytherapy
37
What are electrons used for and why?
Superficial lymph nodes or skin lesions —> deposit most of energy at or near the surface
38
Alpha particles
Positively charged emitted particles
39
Depth of 60Cobalt gamma rays? What is half life of cobalt?
1 cm (1.2 MeV); half life is 5 years
40
Tumor marker for breast cancer...
Ca 15-3
41
Germ Cell Tumor Markers
``` Dysgerminoma = LDH +/- bHCG Endodermal sinus = AFP Immature teratoma = +/- AFP Choriocarcinoma = bHCG Mixed germ cell = +/- AFP and bHCG Embryonal = bHCG +/- AFP Polyembryoma = bHCG +/- AFP ```
42
What does thumbprinting on an abdominal X-ray mean?
Sign of colonic inflammation - C diff, UC, ischemia colitis
43
In what germ cell tumor do we see multinucleated giant cells?
dysgerminoma (make bHCG)
44
What are Sedlis’ criteria?
``` High-intermediate risk factors for cervical cancer Treat with RT if... -deep stromal invasion (outer 1/3) -LVSI -tumor > 4cm ```
45
What tumor do you NOT want to radiate?
Verrucous carcinoma - can become more aggressive with RT
46
How to distinguish an endometrial stromal nodule from low-grade ESS
Tumor circumscription - LGESS shows irregular nodular growth pattern and worm-like plugs that fill and distend myometrial veins; with ESN there is no vascular invasion and a non-infiltrative border
47
Translocations associated with endometrial stromal sarcomas
``` LGESS = JAZF1/SUZ12 (t(7; 17)(p15;q21) HGESS = YWHAE/FAN22 ```
48
Hemostatic agents
Fibrillation Tisseal (can use in a patient with a defective clotting system ie DIC) Floseal/Surgiflo Gelfoam
49
How does hyperglycemia impair healing/increase infections?
Increased glucose levels impair phagocyte function and chemotaxis of granulocytes; also impairs fibroblast function
50
At what chronic steroid dose do we need to be concerned about adrenal insufficiency?
20 mg of prednisone daily for > 5 days
51
Definition of SIRS/sepsis
SIRS = two of more of the following in a setting of inflammation: temp > 38 or < 36, pulse > 90, RR > 20 or PaCO2 < 32, WBC > 12K or < 4K or > 10% band forms Sepsis = SIRS due to known infection Severe sepsis = sepsis with evidence of organ dysfxn, hypotension or hypoperfusion
52
What is Xgris?
Drotrecogen alpha - a recombinant form of human activate protein C which is frequently deficient in sepsis —> was previously used in sepsis but no longer
53
ASA classes
I: no chronic medical problems II: Optimal control of mild chronic disease III: Severe disease that limits activity without incapacitation IV: Severe, incapacitating disease with constant threat to life V: Moribund, death likely within 24 hours with or without surgery
54
MET as measure of functional capacity
1 MET = self care, walk around house, walk 1-2 blocks at 2-3mph 4 MET = can climb a flight of stairs, walk up a hill, walk on level ground at 4 mph, run a short distance, move furniture, play golf 10 MET = Strenuous activity, swimming, skiing
55
NY Heart Association Functional Classification of Heart Disease
I: Can carry 24 pound object up 8 steps, walk 5 mph, carry 80# object shovel snow II: Can walk 4 mph, rake or weed garden, have sex, walk up 8 steps III: Can make bed, push lawn mower, shower, walk 2.5 mph, dress IV: None of the above
56
Equation for SVR
SVR = [(MAP-PAWP)/CO]*80 Normal 700-1600 dynes/sec/cm-5
57
What on PFTs predict high risk surgical candidate?
FEV1 < 1L, FEV1/FVC < 75%, MMV < 50%
58
How far prior to surgery should a patient stop smoking to decrease risk?
8 weeks
59
How to calculate anion gap?
AG = Na - (Cl + HCO3) Normal = 12 +/- 4
60
How to calculate serum osmolality?
Osmolality = 2[Na + K] + urea/2.8 + glucose/18

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