PERIOPERATIVE Flashcards
1
Q
urine dipstick positive for “trace” blood without RBCs
A
myoglobinuria
2
Q
serum CK seen in rhabdo
A
10 fold upper limit of normal
3
Q
potassium during and after exercise
A
rise markedly during extreme exercise but fall to concentrations well below baseline even at 5 min after cessation of activity and remain below baseline for several hrs
directly proportional to bulk of muscle mass used during exercise
4
Q
change in pH of 0.1 equates to a change in bicarb of approx
A
6 mEq/L
5
Q
how do you measure anion gap
A
Na + K - Cl - HCO3
6
Q
high anion gap causes
A
Methanol ingestion Uremia DKA Propylene glycol Isoniazid intox Lactate Ethylene glycol ingestion Rhabdo Salicylates
7
Q
fenestrating subtotal chole
A
leaving infundibulum/cystic duct orifice open with placement of drain in Morison poiuch
8
Q
reconstituting method for subtotal chole
A
closure of a cuff of infundibulkum over the top of the cystic duct orifice
9
Q
highest risk of stroke according to CHADS VASC
A
age 75 or older, previous stroke/TIA
10
Q
variables involved in Frailty index
A
comorbidiites
ADL
attitude
Nutrition
11
Q
gram negative infections resistant to other antibiotics - consider what type of abx?
A
aminoglycoside
12
Q
acid base disturbance seen in malignant hyperthermia
A
respiratory acidosis and in most cases metabolic acidosis
13
Q
pathophys of MH
A
uncontrolled release of intracellular calcium from SR of skeletal muscle –> abnormal skeletal muscle metabolism –> skeletal muscle contraction, rigidity, increased oxygen consumption and CO2 production
14
Q
which type of anesthetics are known triggers for MH
A
all inhalation anesthetics EXCEPT ITROUS OCIDE
succinylcholine
15
Q
dose of dantrolene
A
2.5 mg/kg
16
Q
MOA of dantrolene
A
inhibits ryanodine receptor channel which reduces RyR1 channel activity in muscle cells
17
Q
tx of MH aside from dantrolene
A
admin of IV saline at 4 degrees celsius
topical ice to all exposed areas
peritoneal washing with cold saline
18
Q
what electrolyte can worsen the clinical syndrome of MH
A
calcium!
19
Q
repeated ventricular dysrhythmias in MH - treatment?
A
amiodarone
20
Q
first sign of MH
A
increase in end tidal CO2
21
Q
1st to go down and last to recover from paralytics
A
neck msucles and face
22
Q
last muscle to go down and first to recover from paralytics
A
diaphragm
23
Q
depolarizing paralytic
A
succinylcholine
24
Q
which non depolarizing agent undergoes hoffman elimination
A
cis atracurium
25
which non depolarizing agent can be used in liver and renal failure
cis atracurium
26
rocuronium undergoes what kind of metabolism
hepatic
27
pancuronium undergoes which metabolism
renal
28
most common side effect of pancuronium
tachycardia
29
which drugs should be given with neostigmine/edrophonium
atropine or glycopyrrolate to counteract effects of generalized acetylcholine overdose (these drugs block acetylcholinesterase)
30
if thrombotic risk is high and hemorrhagic risk is intermediate
continue ASA
discontinue plavix
Resume within 24-72 hr with loading dose
consider bridging with short acting IV APT
31
anti PD-1
pembrolizumab
32
anti CTLA-4
iplimumab
33
anti MEK
trametinib
34
"-tinib"
tyrosine kinase inhibitor
35
"-zomib"
proteasome inhibitor
36
"ciclib"
cyclin dependent kinase inhibitor
37
prehabilitation to reduce postop complications has been shown to decrease
ICU LOS
38
preoperative oral carb loading will
reduce insulin resistance
39
after stopping blood transfusion, best option in mgmt for treating incompatibility transfusion reaction
IVF resuscitation with NS, goal UOP 100 mL/hr
40
how to prevent future febrile transfusion reactions
leukocyte filters
41
MOA of milrinone
PDE-3 inhibitor
decreases cAMP degradation and improves myocardial contractile mechanism by increasing inflxu of calcium into cells
Peripheral vasodilation and reduced resistance
same MOA as cilostazol
42
MOA of midodrine
alpha 1 receptor agonist causes vasoconstriction by increasing phospholipase C activity
43
alpha adrenergic anatgonists - MOA and examples
reduce arteriolar resistance by blocking alpha receptors normally bound by epi and norepi. common ones are dozazosin, prazosin and tamsulosin
44
MOA Factor V Leiden
factor V is usaually inactivated by an activated protein C
45
MC fisolated gram negative and gram positive organism assoc with VAP
P. aeuruginosa
| Staph aureus
46
highest percentage of RAS mutations
pancreatic adenoCA
47
during the 1st 24 hrs stress or starvation, organ with highest glycogen stores
liver
48
2/3 of bodys glycogen stores are where
skeletal muscle
| muscle doesnt have enzyme glucose 6 phosphatase which allows release of free glucose into circulation
49
ID accessory spleen
technetium sulfur colloid scan
50
during wound healing when does the maximum accumulation of collagen occur
day 21
| after this the AMOUNT stays the same but continued collagen cross linking improves strength
51
first cells to arrive in wound
platelets
52
predominant cell type days 0-2 injury
PMNs
53
predominant cell type days 3-4 injury
macrophages
54
predominant cell type day 5 + after injury
fibroblasts
55
most impt factor in healing open wounds
epithelial integrity
56
most important factor in healing closed incisions
tensile strength
57
predominant collagen type synthesized during proliferation
type III collagen
58
predominant collagen type synthesized during remodeling
type I
59
at 3 weeks of wound healing what is the collagen like
type III replaced by type I
60
osteogenesis imperfecta is due to
type I collagen defect
61
tx of epidermolysis bullosa
phenytoin
62
casue of epidermolysis bullosa
excessive fibroblasts
63
chemo has no effect on wound healing after
14 days
64
keloids - goes beyond or stays within scar confines
goes beyond
65
dense granules contain
adenosine, serotonin and calcium
66
platelet aggregation factors (3)
TXA2
thrombin
platelet factor 4
67
EKG chagne in hypercalcemia
shirtened QT interval
68
most significant facvtors influencing the oxygen content of blood
Hgb and Hct
69
Oxygen content equation
CaO2. = (Hgb x 1.34 x 02 sat) + (0.003 x PaO2)
70
MC cause of emphysematous cholecystitis
Clostridia (anaerobic gram + rods)
71
Clostridia species are what kind of bacteria
anaerobic gram + rod
72
MC small bowel met
melanoma
73
deficiency of C5-C9 would result in
reduced bacterial cell lysis due to difficult in formation of MAC
74
CD4 receptor binding and upregulation of T cell functio nis afunction of
CD4 helper T cells
75
why do transfusions lead to hyperkalemia?
plasma concentration of potassium icnreases by approx 1 mEq/L per day in stored packed RBC due to passive leakage of potassium from RBCs.
76
elemental formulas supply ___ insteado f ___
free AA instead of proteins therefore they are more easily absorbed
77
indications for elemental formulas (3)
inshort bowel syndrome
eosinophilic esophagitis
milk protein allergy
78
most powerful stimulus for adrenal aldosterone secretion
Angiotensin II
79
ACTH and potassium do what to aldosterone secretion
stimulate
80
decrease in plasma sodium has what effect on aldosterone
stimulates release
81
hinchey Ia
confined pericolic inflammation/phlegmon
82
hinchey Ib
confined pericolic abscess (<5 cm)
83
MC side effect Zosyn
diarrhea
84
malignancy assoc with EBV
gastric CA, Burkitt lymphoma, Hodgkins lymphoma
85
which virus is Kaposi sarcoma ssoc with
HHV 8
86
what do you give pt with antithrombin III deficiency
FFP
87
which product contains highest concentration of vWF-VIIII
cryo
88
FFP contains
high levels of all coag factors, protein C, protein S, and AT-IIII
89
best test for liver synthetic function
PT
90
MC bacteria in postop parotititis
staph auerus
91
refractory SB AVM bleeding
thalidomide
92
greatest amt of protein turnover occurs in
skeletal muscle
93
which enzyme cleaves AT I from circulating angiotensinogen
renin
94
acid base disturbance from ileostomy
normal AG metabolic acidosis
95
hypoventilation --> what respiratory disorder
acidosis
96
how does amphotericin B work
prevents fungal growth and kills fungi by binding to fungal cell wall sterols and causing cell death via lysis
97
side effect of amphotericin B
nephrotoxicity (liposomal type has fewer AE)
98
invasive aspergillosis -->
voriconazole
99
candidemia tx
nidulafungin (Eraxis)
100
how do the fungins work
inhibit synthesis of cell wall glucan
101
how does voriconazole work
inhibits ergosterol synthesis which is needed for cell wall
102
tx of fungal sepsis OTHEr than candida and aspergillus
liposomal amphotericin
103
function of IL 2 and who is it secreted by
regulkates activity of WBC , increases fibroblast infiltration and metabolism
secreted by T lymphocytes
104
IL-4 does what to naive T helper cells
helps then to become T helper.2 cells
105
major liver resection can cause significant decrease in levels of
phosphate - repaid phosphate utilization in regenerating hepatocytes h
106
effect of hyperthermia on phosphate levels
HYPERphosphatemia due to large load of intracellular phopshate that spills into blood secondary to cell death
107
hypoPTH impact on phosphate levels
HYPERphosphatemia as PTH is responsible for stimulating phosphate EXCRETION at level of kidneys
108
metabolic acidosis impact on phosphate levels
HYPERphosphatemia due to compensatory shifts of phosphate from intraceullar to extracellular compartment
109
deficiency in which mineral can lead to hyperglycemia
chromium
110
which 2 vitamin deficiencies can lead to cardiomyopathy
thiamine or B1 as well as selenium
111
deficiency of which vitamin can lead to sideroblastic anemia
pyridoxine or vitamin B6
112
deficiency of essential FA
dermatitits, hair loss, thrombocytopenia
113
vitamin E deficiency
neuropathy, ataxia, retinol degeneration, hemolytic anemia, infertilita
114
prerenal azotemia will have what imapct on urine sodium
decrease to <20 because it stimulates release of aldosterone which leads to resorption of sodium rom collecting ducts
115
if renal failure due to retroperitoneal fibrosis occurs the tx is
surgery to free up the ureters should be done
| if active infection can de percutaneous nephrostomy untik definitivie surgery can be performed
116
which phase of cell cycle is most susceptible to radiation
M phase
117
MOA of tamoxifen
estrogen agonist in non breast tissues but competitive estrogen antagonist in the breast
118
where does the process of collagen production begin in the prolif phase of wound healing
finroblast
119
highest rate of blood transfusion related infection
hepatiatis B
120
contraindications to resection of hepatic mets in GI NET
```
diffuse bilobar liver involvement
pre existing liver dysfunction
extrahepatic mets
poorly differentiated CA
inability to resecvt majority of tumor
```
121
carcinoid syndrome MC in pts with tumors located where in GI tract
midgut (jejunum, ilkeum and cecum)
122
how much fluid is ABSORBED by small bowel daily
8.5 L (out of 9L total)
123
howm uch fluid produced via saliva daily
1500 mL
124
Ig most commonly provided to neonate during breast feeding
IgA
125
initial Ab secreted after exposure to antigen
IgM
126
MC Ab in spleen
IgM
127
most abundant antibody in body
IgG
128
Which Ig crosses placenta
IgG
129
whcih Ig is a membrane bound receptor on B cells
IgD
130
how many antigen binding sites does IgM have
10 (everyone else has 2)
131
secondary lymphoid organs
spleen, LN
132
bolus feeds should only be delivered through
stomach NOT jejunum
133
MC genetic alteration in pancreatic CA
KRAS
134
MOA metronidazole
produces O2 radicals that break up DNA structure
135
inhibition of protein synthesis by acting on 50S ribosomal subunit describes what 3 drugs
linezolid
erythryomycin
clindamycin
136
inhibition of protein synthesis by acting on 30S ribosomal subunit describes what 2 drugs
tetracycline
| aminoglycoside
137
inhibitor of RNA polymerase
rifampin
138
which abx class considered bactericidal
aminoglycosides
139
which abx are PABA analogues and inhibit purine synthesis
sulfonamides
140
MCC LGIB in AIDS pt
CMV
141
Dabigatran prolongs what time
PTT but NON DOSE RELATED FASHION
142
Xarelto elevates what lab
aPTT and PTT although inconsistently
