Pretest Flashcards
How does losing the ileum put someone at increased risk of nephrolithiasis?
Ileum reabsorbs FAs. WIthout ileum, more fatty acids reach the colon where they combine with Ca2+, leaving free oxalate to be reabsorbed. Excess oxalate is excreted by kidneys forming calcium oxalate stones
Aspirin toxicity can lead to metabolic acidosis. It also leads to resp alkalosis?
resp alkalosis -hyperventilation (increase pH, decrease pCO2) driven by direct stimulation of respiratory center
Someone presents with bleeding, normal PT, PTT and bleeding time, but decrease fibrinogen & plt count hours after surgery. What to suspect
suspect error in surgical control of blood vessels in bleeding during early postop period
Acute mesenteric ischemia without peritoneal signs –> next step? Acute mesenteric ischemia w/ peritoneal signs –>
Acute mesenteric ischemia w/o signs –> angiography
Acute mesenteric ischemia w/ peritoneal signs –> celiotomy
Worry about what when you have large blood tx without FFP and plts
dilutional thrombocytopenia & deficiency in factors V and VIII
What are the 3 metabolite disturbances when you start refeeding someone who is super malnourished. Why does this happen
refeeding –> rise in insulin in response to carbs –> electrolytes are shifted intracellularly –> hypokalemia, hypomagnesemia, hypophosphotemia.
-most common cause of death is cardiac arrhythmia
Factors that predispose to fistula formation and poor healing
Foreign body Radiation Inflammation or Infection Epithelization Neoplasm Distal obstruction Steroids
Also output > 500 cc/day
Billroth I vs Billroth II
Billroth I: operation in which the pylorus is removed and the proximal stomach is anastomosed directly to the duodenum
Billroth II: operation in which the greater curvature of the stomach is connected to the first part of the jejunum in end-to-side anastomosis.
After sigmoid resection, 10 d later, pt develops left flank pain, decreased urine output, leukocytosis. CT shows left hydronephrosis but not abscess. Suspect and do what?
IV pyelogram for suspected ureteral injury
Post-thyroidectomy w/ tingling sensation in hands, anxious, muscle cramps. What to suspect? How to treaT?
parathyroidectomy
treat with IV calcium
+ chovstek sign, prolonged QT on EKG, trosseau sign -suspect
hypocalcemia
if you give someone too much Normal saline, what kind of metabolic disturbance can you get?
NS actually has 154 mEq/L of both Na+ and Cl-
When given in large amts, can overload kidneys’ ability to excrete Cl- ion –> acidosis
How to manage someone with large ostomy outputs?
LIke large outputs from NG tube, worry about metabolic disturbances like hypokalemia, acidosis so manage with fluid replacement and stool bulking agent
Stresses increase metabolic rate. How much do these following situations increase metabolic rate?
- multiple organ failure
- 3rd degree burns involving 60% of BSA
- postoperative
- multiple organ failure - 1.5x
- 3rd degree burns involving 60% of BSA - 2.0x
- postoperative -1.1x
Pt with a trach who develops significant bleeding from tracheostomy. Most likely a sentinel blood from which artery? What to do about it?
- sentinel bleed from tracheoinominate artery fistula with greater than 50% mortality rate
- attempt to reintubate pt –> OR
List 5 situations that make for reasonable attempt at extubating a pt
- rapid shallow breathing index btw 60-105 *** RR/Vt
- negative inspiratory force should be at least greater than 20 cm H20
- wean pt to 5 cm H20 PEEP
- minute ventilation
Which inhalational anesthetic to avoid bc of accumulation in air-filled cavities during general anesthesia
nitrous oxide (low solubility, less dense than air)
ARDS: what you find on CXR what is PaO2/FiO2 pulmonary wedge pressure What are the 3 major physiologic alterations
CXR: b/l pulm infiltrates
PaO2/FiO2: less than 200
pulm wedge pressure normal at
What does low, mod, high doses of dopamine do?
t1/2 of dopamine is about 1 min so often given as an IV drip
@ all doses, dopamine increases coronary blood flow
low: vasodilation of renal and mesenteric vasculature, mild vasoconstriction of peripheral bed redirecting blood flow to kidneys and bowel
mod: B1 receptor activity predominates –> increased inotropy –> increased CO and BP
high: a1 receptor –> peripheral vasoconstriction shifting blood from extremities to organs, decrease kidney function, HTN
What’s the pharm agent of choice for a failing heart in that it can increase CO without creating too high a myocardial oxygen demand?
dobutamine is an inotropic agent of choice in cardiogenic shock as a b agonist it improves cardiac performance in pump failure both by increasing inotropy and peripheral vasodilation with minimal chronotropic effects
An epidural catheter for pain relief can cause respiratory acidosis, increased somnolence. What to do?
d/c epidural catheter
can also treat with iv naloxone
For local anesthetic, what’s the maximal safe total dose of lidocaine? What does epinephrine do?
4.5 mg/kg
epinephrine can double the infiltration anesthesia, and increase maximal safe total dose by 1/3 by decreasing rate of absorption
Neurogenic shock (hypotensive and bradycardic) -what to do?
fluid then vasoconstrictors like dopamine or phenylephrine
What’s a reliable indicator of alveolar ventilation?
PaCO2 b/c highly efficient at diffusing
Alveolar hypoventilation has what ABG finding
resp acidosis, hypoxemia and hypercarbia
Pts with PE, pulmonary edema, signficant atelectasis have what ABG findings
significant hypoxemia but normal pCO2 or hypocarbia b/c can hyperventilate to compensate so a resp alkalotic picture
Malignant hyperthermia is characterized by fever, tachycardia, increased O2 consumption, increased CO2 production, hyperkalemia, myoglobinuria, acidosis, rigidity. How to treat?
termination of surgery
100% oxygen
IV dantrolene
Urine alkalinization
Someone develops hyperkalemia after induction. What’s the suspect?
succinylcholine -a depolarizing NM blocker can increase K+ up to 1.0 mEq/L w/in a few min
Pancuronium is a muscle relaxant and is assoc with what side effect
tachycardia
If someone needs volume status to be monitored and assess for need of dobutamine. What can be used to monitor
pulmonary artery catheter
Wasting of intrinsic muscles of hands, weakness and pain at wrist -which nerve is involved
ulnar
briefly go thru the 3 processes of wound healing
1) inflammation: rapid influx of neutrophils then 2 d by mononuclear cells.
2) proliferation: angiogenesis and collagen formation fibroblasts enter in day 3)
3) remodeling: @ 2-3 wks, type 3 –> type 1 collagen
Mohs surgery vs wide local excision -any differences in cure rate?
no difference
When should you excise areas of third/deep second degree burns?
3-7d after injury
There are 3 main topical agents used to treat burns. List then and their assoc side effects
1) silver nitrate: electrolyte abnormalities, methemoglobinemia (hyponatremia, hypokalemia, hypocalcemia, hypochloremia)
2) silver sulfadiazine: neutropenia
3) mafenide: metabolic acidosis 2/2 to inhibition of carbonic anhydrase
Clefts of the lip and palate -may need speech therapy. When is the rough time period in which these should be fixed?
lip repair in 1st 3 months
palate at 12-18 months
what is a marjolin ulcer?
a squamous cell carcinoma that develops in a chronic wound such as previous burn scars or a sinus tract
Compartment syndrome -what pressure is diagnostic
> 30 mmHg
What are 3 wounds that should not be closed?
1) elapsed time to presentation > 6 hrs
2) dirty wounds or contaminated (animal bites)
3) traumatic wounds (puncture, gunshot, crush)
Skin lesion that is described as rolled, with pearly borders that doesn’t have a precursor lesion, has slow growth rate
basal cell
Someone presents with painless ulceration over left medial malleolus with surrounding brawny induration. What is it and how to treat?
venous stasis ulcers
treat with leg elevation, compression stockings and local wound care
Trauma with CXR showing air fluid level in LLL field. You put in NG tube and it coils upward into the left chest. What to suspect
acute diaphragmatic rupture –> OR for lap
If someone has complete transection of common bile duct, what to do?
If pt is stable –> choledochojejunostomy
If pt is unstable –> can place a T tube
What are things that require formal neck exploration?
- acute signs of airway distress (stridor, hoarseness, dysphonia)
- visceral injuries (subcut air, hemoptysis, dysphonia)
- hemorrhage (expanding hematoma, unchecked external bleeding)
- neuro deficits
- hemodyn unstable with neck injury
Blunt abd trauma with upper abd pain, n/v. UGI series shows total obstruction of duodenum with a COILED SPRING APPEARANCE in 2nd and 3rd portions. This is classic for? How to manage?
Classic for duodenal hematoma that presents as a proximal bowel obstruction w/ abd pain and sometimes a palpable mass.
Initial management is observation and NG suction; usu self-resolves
30 male is stabbed in the arm without evidence of vascular injury. Which structure is most likely injured if pt cannot flex his 3 radial digts?
median nerve
someone with CO poisoning with throbbing headache, n/v, dizziness, visual disturbance. Get carboxyhb level and it’s at 31% what to do?
100% oxygen until COHb
Dobutamine is the inotropic agent of choice for cardiogenic shock, but what if pt is refractory. What to do next
mechanical circulatory support with intra-aortic balloon pump
Why do you have to worry about the eyes in someone with electrical burns
can result in cataract development
Any gunshot wounds below T4 should have exp lap b/c often assoc with intraabd injuries. When should you do exp thoracotomy?
1) 1500 mL of blood removed on initial chest tube placement
2) persistent bleeding at rate of 200 ml/h for next 4 hrs or 100 ml/h for 8 hrs
If there’s crepitus in soft tissue, suspect anaerobic infections. What to do?
prompt surgical debridement and IV abx
Cardiac contusion from MVC is most common of all cardiac injuries, usu in persons who sustain direct blow to sternum. How to manage
Get EKG, put on tele for 24-48 hrs, ECHO
If hemo stable, no need for ICU
Tension pneumo is treated first with needle decompression where?
2nd intercostal space mid-clavicular
Lactate in LR is metabolized to what by the liver
bicarb
What is pneumatic anti-shock gargment (PASG)?
inflatable overalls with 3 compartments (2 for legs, 1 for the abdomen) used to elevate BP by increasing PVR. beneficical for controlling bleed from pelvic fractures by decreasing pelvic volume and immobilization to restrict fracture movement.
Absence of sepsis, how to manage enterocutaneous fistulas
initially treated non-operatively with bowel rest, TPN and correction of electrolyte abnormalities
How come small bowel fistulas (stomach to mid-ileum) are less likely to close than distal fistulas?
b/c they tend to produce a high output and therefore less likely to close
In repairing a vascular problem (for ex, GSW to left thigh causing 5 cm portionof fem artery to be destroyed), when do you do primary anastomosis vs vein graft?
if 5 cm is destroyed, it’s impossible to perform tension free primary anastomosis and therefore a vein graft is repair of choice
Diagnostic peritoneal lavage has largely been replaced by FAST in assessing for intraabd injuries. What 4 conditions of DPL necessitate exp lap?
1) aspiration of 10 cc of gross blood initially
2) > 100,000/microL of RBC
3) > 500/microL WBC
4) increased amylase, bilirubin or alk phosp
Pulm contusion wont show up on CXR initially. It is hemorrhage and edema of lung parechynma without parencyhmal disruption. How to manage?
supportive
- pain management
- pulm toilet
- maintenance of good O2
Tracheobronchial injuries can lead to
pneumothorax subcut emphysema pneumomediastinum hemoptysis resp distress
If someone has laryngeal obstruction, what’s the choice of intubation?
cricothyroidotomy
What’s the principle cytokine mediator in gram neg shock and sepsis related organ damage that is produced by activated macrophages, monocytes
TNF
Someone had a liver tx 5 years ago, now presenting with increased bilirubin. Liver biopsy shows paucity of bile ducts. What is this called?
vanishing bile duct syndrome due to immune-mediated injury to biliary epithelium.
Treatment should be re-transplantation
What is the purpose of performing a cross match before organ transplantation?
whether recipient has circulating antibodies against donor HLA antigens
so you take donor lymphocytes and mix with recipient serum complement
How does cyclosporine work?
calcineurin inhibitor that inhibits IL-2 production affecting T cell actions
If during transplant, the kidney turns blue and swollen, what to suspect and what to do?
suspect hyperacute rejection and should get intraop biopsy to confirm
Size and ABO type matter for heart transplant, and not tissue typing why?
Tissue typing takes time. In heart tx, time from outside body (ischemia) is a significant predictor of poor outcome
4 wks following cadaveric kidney tx, pt has hypertensive nephropathy w/ cre of 3.1. Renal US shows mild edema with normal flow in both renal arteries and veins. What’s next step?
Do biopsy and treat with high dose steroids, immunoglob therapy b/c most likely acute rejection (1 wk -3 mo post transplant)
CMV infection post-transplant peaks when? Classic signs?
peaks at 6 weeks
- classic signs: fever, malaise, myalgia, arthralgia, leukopenia.
- other signs: pneumonitis, ulceration, hemorrhage in stomach, duodenum, colon, heptatis, esophagitis, retinitis, pancreatitis, encephalitis
MELD score is sued for?
end stage liver disease at greatest risk of mortality within 3 months
- helps base liver allocation on objective variables like
1. total bilirubin
2. INR
3. creatinine
What is OKT3?
monoclonal antibody against CD3 antigen complex on T cells with side effects including noncardiogenic pulmonary edema, encephalopathy, aseptic meningitis, nephrotoxicity
Pheo is assoc with which 4 conditions
MEN 2a
MEN 2b
VHL disease
NF-1
how does radiation therapy damage cancer cells?
mostly in mitotic phases and directly and most commonly from free oxygen radicals
Cardiac allograft have cold preservation time of 4-5 hrs making what impractical in comparison to renal allografts
tissue typing
List side effects assoc with these chemo drugs:
1) doxorubicin
2) cyclophosphamide
3) bleomycin
4) vincristine
5) cisplatin
6) 5-FU
1) doxorubicin -cardiomyopathy
2) cyclophosphamide -hemorrhagic cystitis
3) bleomycin -pulmonary fibrosis
4) vincristine -peripheral neuropathy
5) cisplatin -ototoxicity, neurotoxicity, nephrotoxicity
6) 5-FU -mucositis, dermatitis, cerebellar dysfunction
What is post-transplant lymphoproliferative disorders
post-tx malignancies assoc with viruses like EBV, HPV, HIV, hep
Thyroid scan shows a single focus of increased isotope uptake. What is it most likely?
hypersecreting adenoma
Graves shows what on thyroid scan
diffuse uptake of radioactive uptake iodine
Several hrs after post-thyroidectomy, pt develops progressive swelling under the incision, stridor, difficulty breathing. Intubate and then what?!
wound exploration bc highly suspicious of wound hematoma
Inflammatory breast cancer can present with peau d’ orange. Can see neoplastic cells in dermal lymphatics. How to treat?
multimodality with surgery, chemo and radiation
15F with negative b hcg with galactorrhea. What to suspect? What are other symptoms? How to manage?
- prolactinoma
- bitemp hemianopsia, amenorrhea, lack of libido, impotence, infertility
if asymp –> observation
if symp –> dopamine agonists
surgery only if symp persist despite medical therapy and/or pt doesn’t want to be on life-long dopamine agonists
A sestamibi parathyroid scan is a procedure in nuclear medicine which is performed to localize parathyroid adenoma. If it shows persistent uptake in parathyroid gland, what to suspect
parathyroid adenoma
Adrenal adenomas should be resected if they’re functioning and if non-functional but greater than 6 cm. After adrenlectomy of a functioning adenoma, what therapy is necessary?
steroid replacement may be required for up to 6-12 months even with a normal functioning contralateral adrenal gland.
FNA of LNs in someone with thyroid mass showing calcified clumps of sloughed cells. what to suspect and what to do
papillary thyroid carcinoma
do total thyroidectomy with modified neck dissection, may need radioactive iodide treatment post-surg
LCIS is a risk factor for
invasive breast cancer most commonly ductal carcinoma
confers a > 5x increased risk in both breasts
breast mass –> firm, lobulated with whorl-like pattern in 14 yr old girl, suspect
fibroadenoma
Paget disease of breast presents with nipple eczema & erosion. How to treat?
radical masectomy b/c up to 20% have assoc breast cancer likely infiltrating ductal carcinoma
How to prevent thyroid storm in operating room in someone with Graves?
give drops of lugol iodide solution daily beginning 10 days preop
What is osteitis fibrosa cystica?
condition assoc with hyperparathyroidism characterized by severe demineralizaton with subperiosteal bone resorption, bone cysts and tufting
How to treat thyroid storm?
rapid fluid replacement, anti-thyroid meds, b blockers, iodine solutions and steroids
plasma aldosterone/plasma renin of 25-30/1 is strongly suggestive of
primary hyperaldosteronism aka Conn syndrome
Breast biopsy shows cystosarcoma phyllodes a tumor that is most often seen in younger women. Describe its characteristics and how to manage?
can grow to enormous size & ulcerate thru skin, but decreased propensity towards metastasis
treatment is wide local excision w/ a rim of normal tissue
Hurthle cell carcinoma
is a type of follicular cancer except it is often mutlifocal and bilateral, more likely to spread with increased risk of mortality. Best to do total thyroidectomy and central LN dissection
Cushing disease is hypersecretion of ACTH by pituitary gland. 90% due to?
pituitary adenoma makes up 90% of the cases while 10% is due to hyperplasia
Insulinoma is evenly distributed btw head, body and tail of pancreas. If it’s unresectable, what can you give pt?
streptozocin -a potent abx that can selectively destroy islet cells in unresectable cases.
Proctocolectomy for UC can do what for the extraintestinal manifestations (arthritis, aklyosing spondylitis, primary sclerosing cholangitis)
can relieve or resolve extraintestinal manifestations, however, risk of primary sclerosing cholangitis still remains
Whats the most common serious complication of an end colostomy
parastomal herniations
Someone with PUD had antrectomy with vagotomy and present with bloating, cramping, diarrhea, weakness, flushing, palpitations, diaphoresis, and dizziness, what does he have? How to manage
dumping syndrome
initial management includes reassurance, and dietary measures (avoid large amts of sugars, eat freq small meals, and separate fluids and solids)
type II and III gastric ulcers are assoc with hypersecretion of acid. Where are they located
type ii -body of stomach
type iii -prepyloric
Peutz jeghers syndrome
intestinal polyposis and melanin spots of oral mucosa. These polyps are hamartomas with no malignant potential
Gallstone ileus presents why? What will you see on x-ray
someone with chronic cholechothiasis can cause erosion of gallbladder into GI tract (usually fistula forms btw gallbladder and duodenum). Stone will pass thru this fistula to duodenum and can lodge at terminal ileum causing SBO. X-ray will show air in biliary tract
HOw to dx biliary dyskinesia?
CCK-HIDA scan -usu CCK causes contraction of gallbladder with normal EF
In biliary dyskinesia, gallbladder contraction with CCK is low at 15%. Can cure with lap cholec
What to do if you see gallbladder polyps
observe with serial ultrasonds
old person with sudden sharp pain with abdominal mass that doesn’t change with contraction of rectus musle.
hematoma of rectus sheath usu 2/2 to trauma, sudden muscular exertion or anticoag
Liver abscess that is non-rim enhancing with + serology for entamoeba histolytica. how to treat
metronidazole
only in pyogenic hepatic abscesses, do you treat with percut drainage and iv abx
You find femoral hernia in someone. What to do next
elective surgical repair bc femoral hernia has the highest risk of strangulation
what is a pilonidal abscess
from infected pilonidal cyst that typically presents as a painful fluctuant mass located btw gluteal clefts.
Ischemic colitis can present with hematochezia, fever, abd pain. What will colonscopy show? How to manage?
Colonoscopy will show “dusky appearing mucosa”
manage depending on colonoscopy results:
if not full thickness involvement –> IV fluids, NPO, supporive care
If full thickness involvement –> surgery
Acute mesenteric ischemia should be suspected when?
- abd pain out of proportion of physical exam finding
- h/o of Atrial fib
- emergent surgery
T/F: pts can undergo resection of a large fraction of colon and suffer little long-term changes in bowel habits
True
What does the colon absorb
absorb electrolytes, water, short chain fatty acids and vitamins
right colon absorbs more salt and water than left colon
When do you surgically remove hepatic adenomas?
usu found in women on OCPs and stopping OCPS can cause them to shrink, but consider surgical removal if planning pregnancy and or > 4 cm
Focal nodular hyperplasia doesn’t have risk of hemorrhagic rupture or malignancy like hepatic adenoma. How to distinguish btw them if CT is inconclusive
nuclear medicine
hot lesion –> FNH
cold lesion –> hepatic adenoma
What’s the best surgical treatment of biliary stricture?
roux-en-y (end to side) choledochojejunostomy
How does secretin stimulation test work to diagnose ZES
1) fasting gastrin level is measured
2) administer secretin
3) measure gastrin levels at 2, 5, 10, 20 min after
A rise > 200 pg/ml confirms ZES
ZES is usu found within gastrinoma triangle. What is the triangle made of
1) junction of 2nd and 3rd duodenum
2) junction of neck and body of pancreas
3) junction of cystic and common bile duct
List the 5 ranson criteria on admission to hospital for acute pancreatitis
1) age > 55
2) WBC count > 16K
3) LDH > 350
4) AST > 250
5) glucose > 200
List the 6 ransons criteria to assess severitiy of acute pancreatitis within 48 hrs of admission
1) hct fall by 10%
2) BUN elevation by 5
3) serum Ca2+ 4
5) fluid sequestration
6) arterial pO2
Ogilive syndrome is massive colonic dilation in absence of mech obstruction. Must do colonoscopy to rule out mech obstruction. how to manage
1) if bowel rest, NG suction, correction of metabolic abnormalities, d/c meds that diminish GI motility like opioids
2) if > 10 cm, endoscopic colonic decompression or sympatholytic agent like neostigmine
Hemobilia is blood in bile duct that is most commonly caused iatrongenically. What to do to dx? what re 3 symptoms
- abd pain in RUQ, jaundice, GI bleeding
- dx with angiography and endoscopy
When do you do right hemicolectomy with appendectomy in surgical treatment of carcinoid?
1 cm carcinoid at tip of appendix –> no need for hemicolectomy
> 2cm –> do hemicolectomy
Choledochal cyst is a congenital cystic dilataion of extrahepatic biliary duct. what is the classic triad of symptoms. What imaging to do?
Classic triad: epigastric pain, abdominal mass, jaundice
US or ERCP can show cysts
Surgery is advised in all cases –> do complete resection and roux en y choledochojejunostomy
Caroli disease
intrahepatic cystic dilation
Stress ulcers that occur after shock, sepsis, major surgeries, trauma or burns tend to be superficial and involve multiple sites. what’s the pathophys
-Not due to increased gastric acid secretion as much as it’s due to decreased splanchnic blood flow –> ischemic damage to mucosa
Pseudocysts can self-resolve, but after 6 weeks, and it still hasn’t self-resolved, consider intervention as the complications include
gastric outlet obstruction, extrahepatic biliary obstruction, spontaneous rupture
What is a Dieulafoy lesion?
It can cause upper GI bleed. This lesion is usu located distal to GE junction and is an abnormally large submucosal artery that protrudes thru a small, solitary mucosal defect
What are some side effects of total pancreactectomy (also removes duodenum, distal CBD, gallbladder)
- weight loss
- malabsorption/diarrhea
- hypocalcemia
- hypophosphatemia
- diabetes
- iron deficiency bc duodenum is removed which is impt in iron reasborption
- pernicious anemia bc pancreas secretes factor to help with absorption
What’s the most common benign liver tumor
hemangioma
Someone with colon cancer s/p resection in remission presents with super high CEA levels, suspect?
liver mets or peritoneal spread
Why is vasopressin contraindicated in CAD
b/c it causes coronary vasoconstriction exacerbating CAD symptoms
what does abdominoperineal resection entail
removing rectum, anus w/ formation of a permanent end colostomy
thoracentesis of pleural fluid revealing thick purulent fluid with glucose
empyema
3/4 of SVC syndrome are caused by?
bronchogenic carcinoma invading vena cava
What to do in someone with esophageal malignancy presenting with air in mediastinum –> esophageal perf?
left thoracotomy w/ esophagectomy
How to treat lung abscess?
initial treatment: systemic abx for up to 12 wks if necessary
if not improved, then drainage
prolonged high amp contractions in body of esophagus points to diffuse esophageal spasm. What is medical therapy?
CCB
can do myotomy if that fails
Several days post-esophagectomy, pt complains of dyspnea, chest tightness, large pleural effusion. Thoracentesis shows milky fluid consistent with chyle. How to initially manage? what if no improvement? How does the management defer if problem was noticed during surgery?
initial management involves putting in chest tube and low fat diet. If no improvement, then right thoracotomy and ligation of thoracic duct from diaphragm to T6
during surgery, can ligate the thoracic duct
What are 5 ways to prevent spinal cord ischemia/paraplegia during cardiothoracic surgery?
- minimize cross clamp time
- hypothermia
- moderate systemic heparinization
- CSF drainage via lumbar drain
- left heart bypass
surprisingly, postop steroids do not reduce risk
zenker is an outpouching btw
lower pharyngeal constrictor and cricopharyngeus that is tonically contracted
Pt has pain and numbness in right arm and hand exacerbated when arm is raised. What is part of ddx
thoracic outlet syndrome either compression of brachial plexus or subclavian vessels in space bounded by 1st rib, clavicle and scalene muscles.
If continuous infusion of dopamine fails to relieve pt’s hypotension, what to do next
treat with NE
Cardiac arrest in ICU should be treated with
epinephrine but not for long-term, only good for short-term use b/c long term use can lead to renal and splanchnic vasoconstriction, cardiac dysrhythmias and increased heart demand.
- low dose: b1 adrenergic effects predominate –> increase HR, SV and contractility
- high dose: a adrenergic effects –> increased BP and SVR
Leriche syndrome
total occlusion of the aorta at the aortoiliac bifurcation –> claudication of hips, buttocks, thighs, absent femoral pulses, impotence
T/F: negative duplex for DVT is pretty good at r/o DVT.
True
Describe the 3 types of urinary incontinence
- stress: previous birth, aging, neuro injuries (treat wtih estrogen therapy, kegels, timed voiding); treat with SLING
- urge: anticholinergic
- overflow: from bladder outlet obstruction
Hypospadia is often assoc with chordee. Define chordee
ventral curvature of the penis
Treatment for stage A transitional cell carcinoma of bladder.
transurethral resection
intravesicular chemo
How fast should testicular torsion be treated? What to do with the c/l testis?
within 4-6 hrs
orchiopexy both testes
When will you consider surgical intervention for someone with BPH
1- refractory to medical therapy
2 - recurrent UTIs
What’s a classic example that can lead to meniscal tear?
a football player running and getting hit. It’s caused from flexion and rapid rotation.
What are the physiologic steps involved in compartment syndrome
1) decreased capillary blood flow –> loss of O2 delivery to tissues and increased ext edema b/c of increased cap permability
2) compromised venous and lymph flow
3) arterial supply is compromised
Open vs closed reduction, which shortens the period of immobilization
open
Monteggia fracture
- radial head is dislocated
- proximal 1/3 of ulna is fractured
severe pain in left femur that is relieved by aspirin with X-ray showing lucent lesion surrounded by marked reactive sclerosis.
osteoid osteoma -can gradually regress but can excise if causing symptoms
12M pain in left leg worse at night with weight loss. X-ray shows aggressive lesion with permative pattern of bone lysis and periosteal rxn of ROUND cell type.
Ewing’s sarcoma (“onion skinning”)
T/F: depressed or compound require surgical treatment
True
