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surgery > NMS > Flashcards

NMS Flashcards

1
Q

Total body water

A

65% Intracellular

35% Extracellular- 25% Interstitial, 10% Intravascular

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2
Q

2/3 rule

A

Total body water comprises approximately 2/3 of body weight; of this, 2/3 is intracellular, and one third extracellular. Of the extracellular, 2/3 is interstitial, and 1/3 is intravascular.

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3
Q

Blood volume

A

Approx. 7% of body weight

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4
Q

Body water excreted

A
  1. urine- minimum = 0.5 mL/kg/hr

2. insensible loss (sweat, respiration, stool) = 600-900 mL/24 hr

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5
Q

Fluid requirement

A

First 10 kg = 4 cc/kg/hr
Second 10 kg = 2 cc/kg/hr
1 cc/kg/hr for every kg above

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6
Q

1/2 normal Saline (0.5% NaCl)

A

77 mEq/L Na+
77 mEq/L Cl-

Osmolarity = 154 mOsm/L

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7
Q

Normal Saline (0.9% NaCl)

A

154 mEq/L Na+
154 mEq/L Cl-

Osmolarity = 308 mOsm/L

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8
Q

Hypertonic Saline (3.0% NaCl)

A

513 mEq/L Na+
513 mEq/L Cl-

Osmolarity = 1027 mOsm/L

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9
Q

Lactated Ringer’s

A 
130 mEq/L Na+
4 mEq/L K+
2.7 mEq/L Ca++
98 mEq/L Cl-
28 mEq/L Lactate

Osmolarity = 525 mOsm/L

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10
Q

Plasmalyte

A 
140 mEq/L Na+
5 mEq/L K+
3 mEq/L Mg++
98 mEq/L Cl-
27 mEq/L Acetate
23 mEq/L Gluconate

Osmolarity = 294 mOsm/L

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11
Q

Signs of acute volume loss

A

tachycardia
hypotension
decreased urine output

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12
Q

Signs of gradual volume loss

A

loss of skin turgor
thirst
alterations in body temperature
changes in mental status

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13
Q

Signs of acute hypervolemia

A

acute shortness of breath
tachycardia

complications- acute CHF

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14
Q

Signs of chronic hypervolemia

A

peripheral edema

pulmonary edema

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15
Q

hyponatremia

A

serum Na+ < 130 mEq/L

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16
Q

Hyperosmolar hyponatremia

A

Dilutional

Causes: hyperglycemia, mannitol infusion, other osmotic particles present

Tx: correct hyperglycemia or other source

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17
Q

Normo-osmolar hyponatremia

A

Pseudohyponatremia

Causes: hyperglycemia, hyperlipidemia, hyperproteinemia

Tx: none required

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18
Q

Hypo-osmolar hyponatremia

A

True hyponatremia

Hypovolemic
Hypervolemic
Euvolemic

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19
Q

Hypovolemic hypo-osmolar hyponatremia

A

most common
total body sodium low
hypovolemia = ADH secretion, decreased free water excretion
Increased intake of free water from thirst or infusion of hypotonic solution

Dx: Urine osmolarity HIGH, Na LOW
Tx: isotonic fluid infusion, Na+ replacement if deficit is severe

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20
Q

Hypervolemic hypo-osmolar hyponatremia

A

total body sodium high
low cardiac output (less blood to kidneys, free water not excreted)
hypoalbuminemic (ex: cirrhosis) or other edematous state salt (Renin-angiotensin) and free water (ADH) cannot be excreted

Dx: Urine osmolarity HIGH, Na LOW
Tx: treat underlying medical condition, NaCl and free water restriction

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21
Q

Euvolemic hypo-osmolar hyponatremia

A

syndrome of inappropriate antidiuretic hormone (SIADH)

can be stimulated by stress response to trauma and surgery.
free water retained

Dx: Urine osmolarity HIGH, urine Na HIGH
Tx: free water restriction

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22
Q

Acute hyponatremia symptoms

A

acute cerebral edema
seizures
coma

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23
Q

Chronic hyponatremia symptoms

A

usually well tolerated
confusion/decreased mental status
irritability
decreased deep tendon reflexes

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24
Q

Hypernatremia

A

serum Na+ > 150 mEq/L

Sxs: volume depletion (tachy, hypotension)
dehydration (dry mucous membranes, decreased skin turgor)
lethargy
confusion
coma (water shift into intracellular in CNS)

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25
Q

Hypovolemia hypernatremia

A

volume deficit, more free water lost than Na+

Tx: calculate free water deficit
replace half within 8 hrs
second half over 16 hrs

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26
Q

Hypervolemia hypernatremia

A

iatrogenic infusion of too much sodium
rare

Tx: decrease Na+ infusion
free water infusion
diuretics

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27
Q

Free water deficit

A

= 0.6 x BW in kg x (pNA/140 - 1)

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28
Q

Hypokalemia

A

serum K+ < 3.5 mEq/L
Severe < 3.0 mEq/L or less

Sxs: ileus, weakness, respiratory failure, cardiac dysrhythmias

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29
Q

ECG changes in hypokalemia

A

seen when K+ < 3.0 mEq/L

T-wave flattening
T-wave inversion
depressed ST segments
U wave development
prolonged QT interval
ventricular tachycardia
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30
Q

Causes of hypokalemia

A

renal- diuretics, vomiting, renal tubular acidosis
extrarenal- diarrhea, burns
intracellular shift- insulin, alkalotic state
medical disease- hyperaldosteronism, cushing syndrome

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31
Q

Treatment of hypokalemia

A

every 10 mEq of K+ should increase serum concentration by 0.1 mEq/L

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32
Q

Hyperkalemia

A

serum K+ > 6 mEq/L

Sxs: diarrhea, cramping, nervousness, weakness, flaccid paralysis, cardiac dysrhythmias

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33
Q

ECG changes in hyperkalemia

A

peaked T waves
widened QRS
ventricular fibrillation

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34
Q

Causes of hyperkalemia

A

Renal failure with inappropriate consumption/admin of K+
Extracellular shift- rhabdomyolysis, massive tissue necrosis, metabolic acidosis, hyperglycemia
Medical disease-Addison’s disease

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35
Q

Treatment of hyperkalemia

A

Acutely- IV Ca++, stablizes cardiac myocyte membrane to prevent dysrhythmias; glucose/insulin to shift K+ intracellularly; Bicarbonate to shift K+ intracellulary

Removal- ion-exchange resin (K-exylate) binds K+ in colon; Lasix only if kidneys can excrete; Dialysis

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36
Q

Respiratory acidosis

A

decreased ventilation relative to CO2 production, increased CO2 concentration

Causes: most common- decreased alveolar ventilation (respiratory depression, CNS disorder, physical), increased CO2 production (excess enteral carbs)

Tx: increase alveolar ventilation

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37
Q

Metabolic acidosis

A

loss of HCO3-, accumulation of strong anions, accumulation of weak acids

Causes: weak acid (anion gap; renal failure, lactic acidosis, DKA, toxins), strong anion (no gap; hyperchloremic acidosis), loss of bicarb (no gap; excess renal excretion, diarrhea)

Tx: underlying metabolic condition
bicarb only if pH < 7.2

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38
Q

Respiratory alkalosis

A

increase in alveolar ventilation with decrease in CO2 levels

Causes: anxiety, pain, shock, sepsis, toxins, CNS dysfunction, over ventilation

Tx: decrease ventilation, most self-limited

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39
Q

Metabolic alkalosis

A

pH over 7.45 and HCO3- > 26 mEq/L

causes: vomiting, diarrhea (loss of gastric contents), drugs that limit renal excretion of HCO3- (steroids, diuretics)

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40
Q

Primary hemostasis

A

Platelet adherence- glycoprotein Ib and vWF

Platelet activation- produce thromboxane A2 (vasoconstrict); Glycoprotein IIb/IIIa expressed for platelet-platelet adhesion (fibrinogen needed)

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41
Q

Extrinsic pathway

A

Tissue Factor (TF) binds Factor VII -> VIIa acivates Factor X -> Xa converts prothrombin -> thrombin (Va cofactor) -> fibrinogen -> fibrin

XIIIa mediates cross linking of fibrin

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42
Q

Intrinsic pathway

A

Factor XIIa activates XI -> XIa activates IX -> IXa activates X -> Xa converts prothrombin -> thrombin (Va cofactor) ->fibrinogen -> fibrin

XIIIa mediates cross linking of fibrin

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43
Q

Protein C and S

A

degrade factors V and VIII

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44
Q

Antithrombin III

A

inhibits thrombin-Xa complexes

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45
Q

Fibrinolysis

A

t-PA and urokinase-type plasminogen activator (uPA) convert plasminogen -> plasmin which cleaves fibrin

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46
Q

Prothrombin time (PT)

A

measures extrinsic cascade

measurement of vitamin K-dependent coag factors (II, VII, X)

used to monitor warfarin therapy

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47
Q

Activated partial thromboplastin time (aPTT)

A

measures intrinsic cascade

used to monitor pts on IV unfractionated heparin

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48
Q

Hemophilia A

A

Factor VIII deficiency

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49
Q

Hemophilia B

A

Factor IX deficiency

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50
Q

von Willibrand disease

A

most common congenital coagulopathy (1-2%)

vWF deficiency, treated with intranasal/IV DDVAVP

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51
Q

Clean wound

A

incision made under sterile conditions, nontraumatic procedure, does not enter bowel, tracheobronchial tree, genitourinary system, or oropharynx

should be closed primarily, infection rate less than 2%

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52
Q

Clean-contaminated wound

A

bowel, tracheobronchial tree, genitourinary system, or oropharynx was entered under sterile conditions. No evidence of active infection

should be closed primarily, infx rate 3-4%

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53
Q

Contaminated wound

A

major contamination of wound during procedure (ex: stool from colon), fresh traumatic wounds

should be left open, infx rate 7-10%

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54
Q

Dirty and infected wounds

A

established infection present before procedure (ex: appendiceal abscess)

should be left open, infx rate 30-40%

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55
Q

Normal wound healing phases

A
  1. Coagulation phase
  2. Inflammatory phase ~ 1 wk
    a. cellular- PMN (24-48 hr) and macrophages remove necrotic tissue and debris; epithelial bridging
    b. vascular- angiogenesis
    c. mediators
  3. Proliferative phase- fibroblasts form collagen, wound strength increases, wound contraction, 3 wks
  4. Wound remodeling- scar formation
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56
Q

Primary closure

A

skin edges approximated shortly after wound incurred

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57
Q

Secondary intention

A

wounds with risk or current infection left open, heal by epitheliazation and wound contraction

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58
Q

Delayed primary closure

A

heavily contaminated wounds, left open 3-5 days, then primarily closed

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59
Q

Skin grafts

A

graft contains epidermis and portion of dermis, provide epithelial coverage for healing

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60
Q

Flaps

A

Rotation flap- retains normal blood supply, rotated to fill in a defect
Free flap- removed from normal blood supply, moved to another area, vasuclature reanastomosed (ex: toe to hand to form thumb)

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61
Q

Fick equation

A

to determine caloric requirements

cardiac output x arterial-venous oxygen content difference = oxygen consumption

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62
Q

Systemic vascular resistance (SVR)

A

SVR = [(MAP - CVP)/CO] x 80

normal: 800-1200 dynes.sec/cm5

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63
Q

Pulmonary vascular resistance (PVR)

A

PVR = [(MPAP - PCWP)/CO} x 80

normal: 20-120 dynes.sec/cm5

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64
Q

Dopamine

A

low dose (1-3 ug/kg/min)- receptors in kidney and intestine, increases blood flow

med dose (3-10 ug/kg/min)- beta receptor agonist, increase in cardiac contractility, incr CO

high dose (>10 ug/kg/min)- alpha agonist and vasoconstrictor

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65
Q

Dobutamine

A

affects both beta-1 and -2 receptors, increase in cardiac output, vasodilation

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66
Q

Norepinephrine

A

alpha agonist, vasoconstriction, mild beta activity, some increase in cardiac contractility

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67
Q

Epinephrine

A

alpha agonist, some beta agonist effect. vasoconstriction and increased cardiac output

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68
Q

Phenylephrine

A

alpha agonist, pure arterial constriction

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69
Q

Nitroprusside

A

primarily arterial vasodilator

reflex tachy, metabolite is cyanide

70
Q

Nitroglycerin

A

primarily venodilator, coronary artery dilator

71
Q

Shock

A

inadequate tisse perfusion to maintain normal cellular metabolism

72
Q

Hypovolemic shock

A

most common type of shock, hemorrhage most common cause. perfusion defect due to blood loss (decreased preload) -> decreased CO

loss of RBC volume reduces O2 carrying capacity (Hgb)

Tx: volume replacement (2 x IV), stop blood loss

73
Q

Cardiogenic shock

A

inadequate cardiac performance -> decreased CO

most commonly related to MI, also CHF, valvular disease

central venous pressures are elevated

Tx: inotropic support (dopa or dobutamine), nitro to reverse cardiac ischemia

74
Q

Neurogenic shock

A

loss of sympathetic tone -> peripheral vasodilation -> relative hypovolemia, decreased cardiac performance

can be result of vasovagal response, cervicothoracic spinal cord injury, spinal anesthesia

Tx: volume resuscitation, consider phenylephrine or NEpi if unresponsive to volume replacement

75
Q

Septic shock

A

toxins released by microbes -> hyperinflammatory derangements, hypovolemia, cardiac dysfunction, vasodilation

Tx: volume resuscitation, central venous access, consider dobutamine if SvO2 < 70%, consider NEpi or dopa if MAP < 65 mmHg

76
Q

Obstructive shock

A

physical obstruction that decreases cardiac output (ex: tension pneumo, cardiac tamponade, massive PE, venous air embolism)

Tx: volume resuscitation, correct underlying condition.

77
Q

Miscellaneous shock

A

cyanide toxicity, severe hypoxia, normovolemic severe anemia, profound hypoglycemia, anaphylaxis

78
Q

Carcinoma

A

malignancy from epithelium

79
Q

Adenocarcinoma

A

malignancy from epithelium with glandular component

80
Q

Sarcoma

A

malignancy from mesodermal tissues

81
Q

Steps necessary for malignancy

A
  1. expression of cell adhesion molecules
  2. produce extracellular matrix molecules
  3. produce cytoskeletal proteins for motility
  4. produce angiogenic factors for neovascularization
82
Q

Classic symptoms of cancer

A 
CAUTION
Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness
83
Q

Postop fever

A
  1. Wind - post op days 1-3
  2. Water - UTI, post op days 3-5
  3. Wound infections - post op days 5-8
  4. Walk - venous complications
  5. Wonder drugs
84
Q

Indications for operative repair of fistula

A 
FRIEND
Foreign body at fistula
Radiation injury
Injured bowel or inflammatory bowel disease
Epithelialization of fistula tract
Neoplasia or cancer
Distal obstruction beyond fistula
85
Q

symptomatic anemia

A 
tachycardia
oliguria
hypotension
fatigue
syncope
tachypnea
dyspnea
transient ischemic attack
86
Q

preoperative risk factors for mortality in noncardiac surgery

A 
Admission serum albumin
ASA class
Disseminated cancer
Emergency operation
Age
Blood urea nitrogen (BUN) > 40 mg/dL
DNR orders
Operation complexity score
SGOT > 40 IU/mL
Weight loss > 10% in 6 months
Functional status
WBC > 11,000/mm3
87
Q

Perioperative pulmonary edema

A

Causes: Volume overload
Cessation of positive pressure ventilation (increase in preload)
Anesthetic induced myocardial depression
Postop HTN

70% develop within first hour after surgery

88
Q

Indications for emergent dialysis

A 
AEIOU
metabolic Acidosis, can't give bicarb
Electrolyte - hyperkalemia
Intoxication of medication
volume Overload, severe
Uremia - pericarditis, mental status changes, asterixis
89
Q

Anterior mediastinum

A

from sternum to pericardium

contains thymus, lymph nodes, ascending and transverse aorta, great veins

90
Q

Visceral mediastinum

A

from pericardium to anterior longitudinal spinal ligament

contains pericardium, heart, trachea, hilar structures of lung, esophagus, phrenic nerves, lymph nodes

91
Q

Paravertebral sulci

A

potential spaces

contain sympathetic chains, intercostal nerves, descending thoracic aorta

92
Q

Immediate life-threatening thoracic injuries

A
  1. Airway obstruction
  2. Tension pneumothorax
  3. Open pneumothorax
  4. Massive hemothorax
  5. Cardiac tamponade
  6. Flail chest
93
Q

Potentially life-threatening thoracic injuries

A
  1. Tracheobronchial disruption
  2. Aortic disruption
  3. Diaphragmatic disruption
  4. Esophageal disruption
  5. Cardiac contusion
  6. Pulmonary contusion
94
Q

Most common chest wall deformity

A

Pectus excavatum (funnel chest)

95
Q

Poland’s syndrome

A

unilateral absence of costal cartilages, pectoralis muscle, and breast

96
Q

Thoracic outlet syndrome (TOS)

A

compression of neurovascular bundle at thoracic outlet. Brachial plexus compression occurs most offen, vascular compression less frequently

97
Q

Common metastatic pulmonary tumors

A

Colorectal
Breast
Melanoma
Renal

98
Q

Anterior mediastinum mass

A 
4 T's
Thymoma
Teratoma - from branchial cleft pouch
Terrible Lymphoma
Tumor- Germ cell (seminoma, embryonal cell carcinoma, teratocarcinoma, choriocarcinoma, endodermal sinus)
99
Q

Classic triad of mitral stenosis

A

apical diastolic rumble
opening snap
loud first heart sound

100
Q

Coronary artery disease risk factors

A 
HTN
Smoking
Hypercholesterolemia
Family history of heart disease
DM
Obesity
101
Q

Stable angina

A

Unchanged for a prolonged period

102
Q

Unstable angina

A

recent change from previously stable pattern, includes new-onset angina

103
Q

Angina at rest

A

unprovoked by activity

104
Q

Graft of choice for CABG

A

Internal mammary artery (IMA) - 90% 10 year patency

105
Q

Tumors with mets to heart

A

Melanoma
Lymphoma
Leukemia

106
Q

Acute pericarditis

A 
Bacterial infection
Viral infection
Uremia
Traumatic hemopericardium
Malignant disease
Connective tissue disorders
107
Q

Most common congenital heart defect

A

Ventricular septal defects (conoventricular most common)

108
Q

Eisenmenger’s syndrome

A

Development of higher pulmonary vascular resistance that leads to reversal of flow across ventricular septal defect

109
Q

Tetralogy of Fallot

A
  1. Obstruction of right ventricular outflow
  2. Ventricular septal defect (VSD)
  3. Hypertrophy of right ventricle
  4. Overriding aorta
110
Q

wet gangrene

A

infection within nonviable tissue

111
Q

Pentoxifylline

A

for intermittent claudication
reduces blood viscosity by decreasing plasma fibrinogen and platelet aggregation
GI upset

112
Q

Leriche syndrome

A

buttock and thigh claudication
absent femoral pulses
impotence (males)

113
Q

Acute lower extremity ischemia

A

“5 P’s”

  1. Pain
  2. Pallor
  3. Paralysis
  4. Paresthesias
  5. Pulselessness
114
Q

Thrombolytic contraindications

A 
sensory and motor changes on presentation
recent surgery (< 2 wks)
known intracranial pathology
115
Q

Acute mesenteric ischemia

A

surgical emergency, 80% mortality
severe abd pain, out of proportion to PE findings

caused by: embolization, thrombosis, nonocclusive ischemia (ex: cardiogenic shock)

116
Q

Riolan’s arch

A

collateral blood supply between SMA and IMA

117
Q

most common causes of renal artery stenosis

A

atherosclerosis

fibromuscular dysplasia

118
Q

risk factors for AAA

A

Age
Smoking
HTN
Family history

Men > Women 4:1

119
Q

Ruptured AAA Dx

A 
1 Severe pain
2 Pulsatile, tender abdominal mass
3 Shock (elevated HR, unstable BP, or syncope)
120
Q

Ischemic cholitis

A

suspect with post-op diarrhea, stool is heme +

Tx: Hartmann’s procedure: resect necrotic colon, proximal colostomy, distal closure

121
Q

Artery supply to spinal cord

A

artery of Adamkiewicz, arises between T8-T12

122
Q

classic anterior spinal artery syndrome

A

Paraplegia
Rectal and urinary incontinence
Loss of pain and temp sensation
Preservation of vibratory and proprioceptive sensation

123
Q

Raynaud’s phenomemnon

A

associated with scleroderma and collagen vascular diseases.

124
Q

Milroy’s disease

A

Lymphedema that is both congenital and hereditary

125
Q

Chief cells

A

found in fundus of stomach
secrete pepsinogen -> pepsin
stimulated by cholinergic impulses, gastrin, secretin

126
Q

Oxyntic/Parietal cells

A

found in body/fundus of stomach
produce hydrochloric acid and intrinsic factor
stimulated by gastrin

127
Q

G cells

A

found in antrum of stomach

secrete gastrin

128
Q

Carcinoid syndrome

A

flushing
diarrhea
bronchoconstriction
tricuspid and pulmonary valve disease

only in pts with liver mets or primary extraintestinal carcinoid

129
Q

Crohn’s disease surgery indications

A

intestinal obstruction- most common
abscesses and fistulas
perforation, hemorrhage, intractible sxs- less common

130
Q

most common diverticulum of GI tract

A

Meckel’s diverticulum

2 ft from ileocecal valve

131
Q

Familial Adenomatous Polyposus

A

autosomal dominant

mutation of APC gene on chrom 5

132
Q

Amsterdam criteria for HNPCC

A

Three+ relatives with colon cancer (1 first deg)
Colorectal carcinoma in 2+ generations
1+ diagnosed before age 50

133
Q

Colon cancer risk factors

A 
Family history
Ashkenazi Jews
Personal history of colorectal cancer
Personal history of colorectal polyps
Chronic inflammatory bowel disease (UC>Chr)
Age > 50
Diet (high fat, low fruit/veg, high calcium)
low activity level
Obesity
DM
Smoking
EtOH
134
Q

most sensitive indicator of recurrent colorectal cancer

A

CEA- glycoprotein secreted by colorectal tumors
if rising- CXR and abd CT

(nonspecific, also high in cirrhosis, pancreatitis, renal failure, UC, other cancer, smoking)

135
Q

fulminant colitis with toxic megacolon

A

Dilation of transverse colon
Abdominal pain, tenderness, distention
Fever, leukocytosis, hypoalbuminemia
Risk of colonic perforation

136
Q

serologic markers for IBD

A

pANCA (UC)

ASCA (CD)

137
Q

Sulfasalazine

A

main medical treatment for UC

138
Q

Sclerosing cholangitis

A

UC > CD

139
Q

Immunosuppressives for IBD

A

6-Mercaptopurine
Azathioprine
Methotrexate
IV cyclosporine

140
Q

most common benign hepatic tumor

A

Hemangioma

141
Q

benign hepatic tumor strongly associated with oral contraceptives and androgenic steroid use

A

Hepatocellular adenoma

142
Q

sulfer-colloid scan

A

distinguish between Focal Nodular Hyperplasia and a hepatocellular adenoma: FNH takes up sulfer-colloid, adenoma does not

143
Q

benign hepatic tumor of children

A

Infantile Hemangioendothelioma

has malignant potential

144
Q

Most common primary malignant tumor of liver

A

Hepatocellular carcinoma

145
Q

risk factors for hepatocellular carcinoma

A

Chronic hep B
Cirrhosis
Hemochromatosis
Schistosomiasis and other parasitic infection
Carcinogens- polycholirnated bipheyls, chlorinated hydrocarbos, vinyl chloride, nitrosamines

146
Q

most common primary malignant liver tumor in children

A

Hepatoblastoma

147
Q

tumor from bile duct epithelium

A

Cholangiocarcinoma

148
Q

Pringle maneuver

A

control and compression of porta hepatis

used for hemostasis after liver trauma

149
Q

Vasopressin

A

potent vasoconstrictor, lowers portal pressure

150
Q

Somatostatin

A

causes splanchnic vasoconstriction, fewer side effects than vasopressin

151
Q

TIPS

A

Transjugular intrahepatic portosystemic shunt

between a hepatic vein and a branch of the portal vein

152
Q

Salt and water retention in liver failure

A

Due to hyperaldosteronism -> decreased aldosterone breakdown by liver

Tx: diuretics, especially aldosterone antagonists

153
Q

Increase bile flow

A 
Vagal and splanchnic stimulation
Secretin
Theophylline
Phenobarbital
Steroids
154
Q

Release of bile

A

Colecystokinin (CCK)- humoral control

vagal and splanchnic nerves also contribute

155
Q

Acalculous cholecystitis

A

acute or chronic cholecystitis in the absence of stones
acute from burns, sepsis, trauma, or collagen vascular disease
chronic also called biliary dyskinesia

156
Q

Turner’s sign

A

flank eccchymoses from blood dissection of flank tissues

sign of retroperitoneal hemorrhage from sever pancreatic inflammation and necrosis

157
Q

Cullen’s sign

A

periumbilical ecchymosis from blood dissection up falciform ligament

158
Q

Adrenal cortex

A

zona glomerulosa- mineralocorticoids (aldosterone)
zona fasciculata- glucocorticoids (cortisol)
zona reticularis- androgens and estrogens

159
Q

Superior parathyroid origin

A

fourth branchial pouch
close to origin of thyroid

abnormal location- within thyroid, or posterior mediastinum

160
Q

Inferior parathyroid origin

A

third branchial pouch

close to thymic anlage, cross superior in descent

161
Q

Tx for symptomatic hypocalcemia

A

IV Ca2+ gluconate (severe)

162
Q

Thymus embryology

A

Third branchial pouch

descends into anterosuperior mediastinum

163
Q

Sxs of myasthenia gravis

A 
ptosis
double vision
dysarthria
dysphagia
nasal speech
weakness of arms and legs
164
Q

Path of myasthenia gravis

A

autoantibodies against ACh receptors

165
Q

Tx of MG

A

Medically- neostigmine, pyridostigmine (drugs that stimulate NMJ)

Surgically- thymectomy
- post-op plasmapharesis

166
Q

MEN I

A

Hyperparathyroidism
Pancreatic tumors (nonbeta islet cell- ZE synd)
Pituitary tumors

167
Q

Sxs of MEN I

A

hypercalcemia
hypoglycemia
peptic ulcer (pancreatic gastrinoma)
pituitary mass complaints

168
Q

MEN 2A

A

Medullary thyroid carcinoma (medullary hyperplasia of C cells- increased calcitonin)
Pheochromocytomas (B/L)
Parathyroid hyperplasia

169
Q

MEN 2B

A

Medullary thyroid carcinoma
Pheochromocytomas
Marfanoid/multiple mucosal neuromas

170
Q

APUD cells

A

Amine Precursor Uptake Decarboxylation cell system

171
Q

APUDomas

A 
Insulinomas
Gastrinomas (Z-E synd)
Glucagonomas
VIPomas (vasoactive intestinal peptide)
Somatostatinomas
172
Q

Pancreatic cholera (WDHA syndrome)

A

Watery Diarrhea
Hypokalemia (high potassium in stool from hypersecretion)
Achlorhydria

severe diarrhea due to hypersecretion of a pancreatic nonbeta islet cell tumor

surgery (5 decks)

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