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ABS > PERIOPERATIVE > Flashcards

PERIOPERATIVE Flashcards

1
Q

urine dipstick positive for “trace” blood without RBCs

A

myoglobinuria

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2
Q

serum CK seen in rhabdo

A

10 fold upper limit of normal

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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

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4
Q

change in pH of 0.1 equates to a change in bicarb of approx

A

6 mEq/L

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5
Q

how do you measure anion gap

A

Na + K - Cl - HCO3

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6
Q

high anion gap causes

A 
Methanol ingestion
Uremia
DKA
Propylene glycol
Isoniazid intox
Lactate
Ethylene glycol ingestion
Rhabdo
Salicylates
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7
Q

fenestrating subtotal chole

A

leaving infundibulum/cystic duct orifice open with placement of drain in Morison poiuch

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8
Q

reconstituting method for subtotal chole

A

closure of a cuff of infundibulkum over the top of the cystic duct orifice

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9
Q

highest risk of stroke according to CHADS VASC

A

age 75 or older, previous stroke/TIA

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10
Q

variables involved in Frailty index

A

comorbidiites
ADL
attitude
Nutrition

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11
Q

gram negative infections resistant to other antibiotics - consider what type of abx?

A

aminoglycoside

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12
Q

acid base disturbance seen in malignant hyperthermia

A

respiratory acidosis and in most cases metabolic acidosis

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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

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14
Q

which type of anesthetics are known triggers for MH

A

all inhalation anesthetics EXCEPT ITROUS OCIDE

succinylcholine

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15
Q

dose of dantrolene

A

2.5 mg/kg

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16
Q

MOA of dantrolene

A

inhibits ryanodine receptor channel which reduces RyR1 channel activity in muscle cells

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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

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18
Q

what electrolyte can worsen the clinical syndrome of MH

A

calcium!

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19
Q

repeated ventricular dysrhythmias in MH - treatment?

A

amiodarone

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20
Q

first sign of MH

A

increase in end tidal CO2

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21
Q

1st to go down and last to recover from paralytics

A

neck msucles and face

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22
Q

last muscle to go down and first to recover from paralytics

A

diaphragm

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23
Q

depolarizing paralytic

A

succinylcholine

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24
Q

which non depolarizing agent undergoes hoffman elimination

A

cis atracurium

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25
Q

which non depolarizing agent can be used in liver and renal failure

A

cis atracurium

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26
Q

rocuronium undergoes what kind of metabolism

A

hepatic

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27
Q

pancuronium undergoes which metabolism

A

renal

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28
Q

most common side effect of pancuronium

A

tachycardia

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29
Q

which drugs should be given with neostigmine/edrophonium

A

atropine or glycopyrrolate to counteract effects of generalized acetylcholine overdose (these drugs block acetylcholinesterase)

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30
Q

if thrombotic risk is high and hemorrhagic risk is intermediate

A

continue ASA
discontinue plavix
Resume within 24-72 hr with loading dose
consider bridging with short acting IV APT

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31
Q

anti PD-1

A

pembrolizumab

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32
Q

anti CTLA-4

A

iplimumab

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33
Q

anti MEK

A

trametinib

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34
Q

“-tinib”

A

tyrosine kinase inhibitor

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35
Q

“-zomib”

A

proteasome inhibitor

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36
Q

“ciclib”

A

cyclin dependent kinase inhibitor

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37
Q

prehabilitation to reduce postop complications has been shown to decrease

A

ICU LOS

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38
Q

preoperative oral carb loading will

A

reduce insulin resistance

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39
Q

after stopping blood transfusion, best option in mgmt for treating incompatibility transfusion reaction

A

IVF resuscitation with NS, goal UOP 100 mL/hr

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40
Q

how to prevent future febrile transfusion reactions

A

leukocyte filters

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41
Q

MOA of milrinone

A

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

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42
Q

MOA of midodrine

A

alpha 1 receptor agonist causes vasoconstriction by increasing phospholipase C activity

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43
Q

alpha adrenergic anatgonists - MOA and examples

A

reduce arteriolar resistance by blocking alpha receptors normally bound by epi and norepi. common ones are dozazosin, prazosin and tamsulosin

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44
Q

MOA Factor V Leiden

A

factor V is usaually inactivated by an activated protein C

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45
Q

MC fisolated gram negative and gram positive organism assoc with VAP

A

P. aeuruginosa

Staph aureus

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46
Q

highest percentage of RAS mutations

A

pancreatic adenoCA

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47
Q

during the 1st 24 hrs stress or starvation, organ with highest glycogen stores

A

liver

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48
Q

2/3 of bodys glycogen stores are where

A

skeletal muscle

muscle doesnt have enzyme glucose 6 phosphatase which allows release of free glucose into circulation

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49
Q

ID accessory spleen

A

technetium sulfur colloid scan

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50
Q

during wound healing when does the maximum accumulation of collagen occur

A

day 21

after this the AMOUNT stays the same but continued collagen cross linking improves strength

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51
Q

first cells to arrive in wound

A

platelets

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52
Q

predominant cell type days 0-2 injury

A

PMNs

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53
Q

predominant cell type days 3-4 injury

A

macrophages

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54
Q

predominant cell type day 5 + after injury

A

fibroblasts

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55
Q

most impt factor in healing open wounds

A

epithelial integrity

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56
Q

most important factor in healing closed incisions

A

tensile strength

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57
Q

predominant collagen type synthesized during proliferation

A

type III collagen

58
Q

predominant collagen type synthesized during remodeling

A

type I

59
Q

at 3 weeks of wound healing what is the collagen like

A

type III replaced by type I

60
Q

osteogenesis imperfecta is due to

A

type I collagen defect

61
Q

tx of epidermolysis bullosa

A

phenytoin

62
Q

casue of epidermolysis bullosa

A

excessive fibroblasts

63
Q

chemo has no effect on wound healing after

A

14 days

64
Q

keloids - goes beyond or stays within scar confines

A

goes beyond

65
Q

dense granules contain

A

adenosine, serotonin and calcium

66
Q

platelet aggregation factors (3)

A

TXA2
thrombin
platelet factor 4

67
Q

EKG chagne in hypercalcemia

A

shirtened QT interval

68
Q

most significant facvtors influencing the oxygen content of blood

A

Hgb and Hct

69
Q

Oxygen content equation

A

CaO2. = (Hgb x 1.34 x 02 sat) + (0.003 x PaO2)

70
Q

MC cause of emphysematous cholecystitis

A

Clostridia (anaerobic gram + rods)

71
Q

Clostridia species are what kind of bacteria

A

anaerobic gram + rod

72
Q

MC small bowel met

A

melanoma

73
Q

deficiency of C5-C9 would result in

A

reduced bacterial cell lysis due to difficult in formation of MAC

74
Q

CD4 receptor binding and upregulation of T cell functio nis afunction of

A

CD4 helper T cells

75
Q

why do transfusions lead to hyperkalemia?

A

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
Q

elemental formulas supply ___ insteado f ___

A

free AA instead of proteins therefore they are more easily absorbed

77
Q

indications for elemental formulas (3)

A

inshort bowel syndrome
eosinophilic esophagitis
milk protein allergy

78
Q

most powerful stimulus for adrenal aldosterone secretion

A

Angiotensin II

79
Q

ACTH and potassium do what to aldosterone secretion

A

stimulate

80
Q

decrease in plasma sodium has what effect on aldosterone

A

stimulates release

81
Q

hinchey Ia

A

confined pericolic inflammation/phlegmon

82
Q

hinchey Ib

A

confined pericolic abscess (<5 cm)

83
Q

MC side effect Zosyn

A

diarrhea

84
Q

malignancy assoc with EBV

A

gastric CA, Burkitt lymphoma, Hodgkins lymphoma

85
Q

which virus is Kaposi sarcoma ssoc with

A

HHV 8

86
Q

what do you give pt with antithrombin III deficiency

A

FFP

87
Q

which product contains highest concentration of vWF-VIIII

A

cryo

88
Q

FFP contains

A

high levels of all coag factors, protein C, protein S, and AT-IIII

89
Q

best test for liver synthetic function

A

PT

90
Q

MC bacteria in postop parotititis

A

staph auerus

91
Q

refractory SB AVM bleeding

A

thalidomide

92
Q

greatest amt of protein turnover occurs in

A

skeletal muscle

93
Q

which enzyme cleaves AT I from circulating angiotensinogen

A

renin

94
Q

acid base disturbance from ileostomy

A

normal AG metabolic acidosis

95
Q

hypoventilation –> what respiratory disorder

A

acidosis

96
Q

how does amphotericin B work

A

prevents fungal growth and kills fungi by binding to fungal cell wall sterols and causing cell death via lysis

97
Q

side effect of amphotericin B

A

nephrotoxicity (liposomal type has fewer AE)

98
Q

invasive aspergillosis –>

A

voriconazole

99
Q

candidemia tx

A

nidulafungin (Eraxis)

100
Q

how do the fungins work

A

inhibit synthesis of cell wall glucan

101
Q

how does voriconazole work

A

inhibits ergosterol synthesis which is needed for cell wall

102
Q

tx of fungal sepsis OTHEr than candida and aspergillus

A

liposomal amphotericin

103
Q

function of IL 2 and who is it secreted by

A

regulkates activity of WBC , increases fibroblast infiltration and metabolism
secreted by T lymphocytes

104
Q

IL-4 does what to naive T helper cells

A

helps then to become T helper.2 cells

105
Q

major liver resection can cause significant decrease in levels of

A

phosphate - repaid phosphate utilization in regenerating hepatocytes h

106
Q

effect of hyperthermia on phosphate levels

A

HYPERphosphatemia due to large load of intracellular phopshate that spills into blood secondary to cell death

107
Q

hypoPTH impact on phosphate levels

A

HYPERphosphatemia as PTH is responsible for stimulating phosphate EXCRETION at level of kidneys

108
Q

metabolic acidosis impact on phosphate levels

A

HYPERphosphatemia due to compensatory shifts of phosphate from intraceullar to extracellular compartment

109
Q

deficiency in which mineral can lead to hyperglycemia

A

chromium

110
Q

which 2 vitamin deficiencies can lead to cardiomyopathy

A

thiamine or B1 as well as selenium

111
Q

deficiency of which vitamin can lead to sideroblastic anemia

A

pyridoxine or vitamin B6

112
Q

deficiency of essential FA

A

dermatitits, hair loss, thrombocytopenia

113
Q

vitamin E deficiency

A

neuropathy, ataxia, retinol degeneration, hemolytic anemia, infertilita

114
Q

prerenal azotemia will have what imapct on urine sodium

A

decrease to <20 because it stimulates release of aldosterone which leads to resorption of sodium rom collecting ducts

115
Q

if renal failure due to retroperitoneal fibrosis occurs the tx is

A

surgery to free up the ureters should be done

if active infection can de percutaneous nephrostomy untik definitivie surgery can be performed

116
Q

which phase of cell cycle is most susceptible to radiation

A

M phase

117
Q

MOA of tamoxifen

A

estrogen agonist in non breast tissues but competitive estrogen antagonist in the breast

118
Q

where does the process of collagen production begin in the prolif phase of wound healing

A

finroblast

119
Q

highest rate of blood transfusion related infection

A

hepatiatis B

120
Q

contraindications to resection of hepatic mets in GI NET

A 
diffuse bilobar liver involvement
pre existing liver dysfunction
extrahepatic mets
poorly differentiated CA
inability to resecvt majority of tumor
121
Q

carcinoid syndrome MC in pts with tumors located where in GI tract

A

midgut (jejunum, ilkeum and cecum)

122
Q

how much fluid is ABSORBED by small bowel daily

A

8.5 L (out of 9L total)

123
Q

howm uch fluid produced via saliva daily

A

1500 mL

124
Q

Ig most commonly provided to neonate during breast feeding

A

IgA

125
Q

initial Ab secreted after exposure to antigen

A

IgM

126
Q

MC Ab in spleen

A

IgM

127
Q

most abundant antibody in body

A

IgG

128
Q

Which Ig crosses placenta

A

IgG

129
Q

whcih Ig is a membrane bound receptor on B cells

A

IgD

130
Q

how many antigen binding sites does IgM have

A

10 (everyone else has 2)

131
Q

secondary lymphoid organs

A

spleen, LN

132
Q

bolus feeds should only be delivered through

A

stomach NOT jejunum

133
Q

MC genetic alteration in pancreatic CA

A

KRAS

134
Q

MOA metronidazole

A

produces O2 radicals that break up DNA structure

135
Q

inhibition of protein synthesis by acting on 50S ribosomal subunit describes what 3 drugs

A

linezolid
erythryomycin
clindamycin

136
Q

inhibition of protein synthesis by acting on 30S ribosomal subunit describes what 2 drugs

A

tetracycline

aminoglycoside

137
Q

inhibitor of RNA polymerase

A

rifampin

138
Q

which abx class considered bactericidal

A

aminoglycosides

139
Q

which abx are PABA analogues and inhibit purine synthesis

A

sulfonamides

140
Q

MCC LGIB in AIDS pt

A

CMV

141
Q

Dabigatran prolongs what time

A

PTT but NON DOSE RELATED FASHION

142
Q

Xarelto elevates what lab

A

aPTT and PTT although inconsistently

ABS (23 decks)

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