Odds and Ends Flashcards
The ________ is the site of absorption of
vitamin B12 following release of intrinsic factor from the __________
distal ileum
gastric mucosa
If a needle biopsy fails to confirm diagnosis of a suspicious breast lesion, what is the next step?
excisional biopsy
How are venous return and cardiac output affected under general anesthesia?
both are decreased due to sympathetic (central) blockade
In paradoxical rhinorrhea, CSF leaks through the __________, which provides a connection between the middle ear and nasopharynx.
Eustachian tube
beware of postnasal drip/unusually salty taste in mouth!
Presence of a petrous fracture, the opacification of the normally aereated mastoid air cells, and the presence of air in the middle fossa…
temporal bone fracture leading to CSF leak and paradoxical rhinorrhea
Severance of the chorda tympani nerve (which accompanies CN7) will result in
loss of taste in the anterior 2/3 of the tongue
How do you treat CSF leaks caused by nonpenetrating trauma?
Raise head to lower ICP (and decrease fluid flowing out). If persistent, then serial taps or lumbar drain.
The breast tissue extends over the medial margin of the ________ muscle. Which nerve lies on the lateral aspect of this muscle and may be accidentally injured during breast surgery?
serratus anterior; nerve to the serratus anterior
If there is an absence of blood flow in the celiac artery, what collaterals will supply the stomach?
The superior mesenteric artery will supply
the inferior pancreaticoduodenal branch, which
will form collateral branches with the superior
pancreaticoduodenal branch from the celiac
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The effects of (proximal/distal) ligation of the hepatic artery are more drastic.
distal. If you ligate proximally, collaterals beyond the obstruction will supply the organ. Note: hepatic arterial ligation is well tolerated; it decreases portal pressure, but should be avoided in obstructive jaundice or portal vein obstruction.
After gastrin or histamine administration, there is a(n) (increase/decrease) in acid secretion.
Increase. Higher in postsurgical patients than normal individuals or gastric ulcer patients.
What are the three phases of digestion? When is most acid secreted?
cephalic (responding to site of food), gastric (swallowed food activates activity), duodenal (intestine responds to chyme)
Most acid secreted in gastric phase; during intestinal phase, vagus nerve via the enterogastric reflex inhibited to stop acid secretion
The anterior esophageal and gastric plexus is formed mainly from the (left/right) vagus nerve.
Left = ANTERIOR Right = POSTERIOR
Excision of something in the submandibular division may lead to damage of the mandibular division of the facial nerve, causing
mandibular deformity; deformity of the angle of the mouth
Why do patients with lymphoma get gout?
Hyperuricemia results from increased cellular turnover in patients with lymphoma
T/F In osteoarthritis, the WBC is increased.
False. Osteoarthritis is a noninflammatory condition. WBC is normal.
Why might damage to the facial nerve damage ability to close the eye?
The palpebral portion of orbicularis oculi is responsible for closing the eyelid. It is innervated by CN7. Inability to close the eye leads to dryness of the conjunctiva that may cause blindness.
Note: levator palpebrae, innervated by CN3, is responsible for opening the eye.
Dermoid cysts are bilateral in __% of cases.
10%
A large amount of seroanguinous drainage
from an abdominal wound that occurs ____ days post-op is usually the result of dehiscence of the abdominal wound closure
5 to 7
Respiratory failure after starting nutritional support is characterized with which nutritional abnormality?
Hypophosphatemia (a hallmark of “refeeding syndrome”)
Low to moderate levels of PEEP (to prevent alveolar overdistension) and tidal volumes of _______ should characterize treatment for ARDS.
5-7 mL/kg
Minute ventilation of ____ suggests a patient is ready for weaning.
<10L/min
A PaO2/FiO2 ratio of _______ suggests a patient is ready for weaning of mechanical ventilation.
> 300
A rapid shallow breathing index (RSBI) of ____ suggests a patient is ready for weaning.
How do you calculate RSBI?
<105
RR/TV (in L)
A negative inspiratory force of ___ cm of H2O suggests a patient is ready for weaning.
> -20 cm of H2O
T/F: Mean airway pressure does not predict successful extubation.
True
Marjolin’s ulcers are associated with which chronic wounds?
osteomyelitis, radiation therapy, hidradenitis suppurativa, diabetic ulcers
Splenic artery aneurysms in women are almost always caused by ___________
medial dysplasia of the arery (may be the cause of rupture in pregnancy and can be life-threatening of not promptly treated by laparotomy)
Administration of excess ____ will lead to hepatic steatosis within 3-4 weeks. What will liver biopsy show?
excess glucose
Liver biopsy will show fat vacuoles (and LFTs will be abnormal)
What is the treatment for gastric carcinoma?
Subtotal gastrectomy (no need for vagotomy, as gastric cancer patients are invariably achlorhydric)
What antibiotic has been shown to reduce the incidence of pancreatic sepsis in hemorrhagic pancreatitis?
imipenem/cilastatin
A 51yo man presenting with a left varicocele should be investigated for possible:
renal tumor!!! The LEFT side drains into the left renal vein. A renal cell carcinoma occluding the renal vein may also occlude the testicular vein on the left side.
What muscles border the scaphoid?
Abductor pollicis longus and extensor pollicis brevis on the lateral/radial side, and the extensor pollicis longus tendon on the medial/ulnar side
Adrenal masses that are nonfunctional may be left if they are __ cm or less in diameter.
3
What is the treatment of calcified gallbladder?
Cholecystectomy (likely to be carcinoma!!)
Carcinoma in the gastric remnant has been reported in 1/5 of patients who have undergone partial gastrectomy. It usually takes ___ to develop but can be present in as few as __ years after surgery.
usually >15 years; sometimes as little as 5 years
Should be endoscoped (can also obtain a biopsy that way)
What is the major problem associated with the use of cyclosporine?
Nephrotoxicity (ironically, since cyclosporine is the most commonly used immunosuppresion used for renal transplant)
Bladder pressure >20 mm Hg defines
abdominal compartment syndrome
T/F: Pregnant patients who are injured are at high risk for the development of DIC.
True
What is the most pressing indication for operative treatment in a patient with splenic injury?
Hemodynamic instability
This disease is characterized by voluminous diarrhea (5L or more daily) that is rich in potassium and which looks like watery tea:
Are patients acidotic or alkalotic?
WDHA (watery diarrhea, hypokalemia, and achlorhydia syndrome) or VIPoma (vasoactive intestinal polypeptide)
Patients are acidotic
What can help to decrease diarrhea volume in patients with VIPoma?
octreotide
How can the relationship of fasting to diarrhea help distinguish between ZES and WDHA?
In ZES, patietns who fast (or have continuous NG suctioning) stop having diarreha.
In WDHA (vipoma) they don’t!
Migratory necrotizing dermatitis is associated with
glucagonoma
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Target cells are seen in
thalassemia (nucleated red cells)
can have decreased osmotic fragility
What is Felty’s syndrome?
Triad of rheumatoid arthritis, splenomegaly, and neutropenia
What is the difference between benign liver cysts and hydatid cysts and echogenicity on ultrasound?
Hydatid cysts will show internal echoes, while benign liver cysts can be anechoic
What is a high output fistula?
> 500 ml/day
What is the treatment of gram positive spore producing rods in a crepitus wound?
Clostridium –> penicillin G
What is Light’s criteria?
Pleural fluid protein / Serum protein >0.5
Pleural fluid LDH / Serum LDH >0.6
Pleural fluid LDH > 2/3 Serum LDH Upper Limit of Normal (200-300)
What is the difference between a hypertrophic scar and a keloid?
A hypertrophic scar remains within the boundaries of the original wound margins. Bothcan be treated with seroid injections and local pressure dressings
