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PRS RC 2020 > Randomx mix > Flashcards

Randomx mix Flashcards

1
Q

What is SIRS criteria?

A

2 or more of: o Fever > 38C or < 36C o Heart rate > 90 beats / minute o Respiratory rate > 20 or PaCO2 < 32 mmHg o White blood cell count >12,000/mm3, <4,000/mm3, or >10% immature bands

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2
Q

What is sepsis?

A

SIRS + evidence of infection

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3
Q

What is severe sepsis?

A

Sepsis with evidence of end organ function

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4
Q

What is septic shock?

A

Severe sepsis + hypotension

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5
Q

What is the classification for nec fasc?

A

Type I - mixed (aerobic + anaerobic) –> RF: DM, PVD, immunosuppression, recent surgery

Type II - monomicrobial (GAS, Strep pyo, staph aureus, vibrio, aeromonas)

Type III - clostridium perfringens (gas gangrene)

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6
Q

What is empiric therapy for nec fasc?

A

Pip-tazo/carbapenem + clinda + vanco (MRSA)

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7
Q

What is therapy for nec fasc is pen allergic?

A

Fluoroquinolone + flagyl

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8
Q

What is nec fasc with sea water exposure?

A

Add doxy 100mg IV BID or ceftazidime 2g IV q18H for vibrio

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9
Q

What are the phases of lyme disease?

A
  1. Flu like illness, malaise, erythema migran 2. Weeks - neurologic: meningitis, FACIAL PALSY 3. Months-years - recurrent meningitis, neuro deficits, chronic arthritis
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10
Q

What is the treatment for lyme disease?

A

Ceftriaxone 2g IV daily x 12 days

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11
Q

How to clinically differentiate btw preseptal and orbital cellulitis?

A

Orbital: proptosis, pain with eye movements, ophthalmoplegia, diplopia

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12
Q

what is the recommended HIV post-exposure prophylaxis?

A

Zidovudine (AZT) + lamivudine (3TC) +/- third agent Nelfinavir

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13
Q

what is Melkersson-Rosenthal syndrome?

A
  1. Recurrent unilateral facial paralysis 2. Non-inflammatory facial edema 3. Ligua plicata 4. AD!!!
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14
Q

What is Ramsay Hunt syndrome?

A
  1. Varicella Zoster infection of geniculate ganglion 2. Unilateral facial paralysis 3. Ear pain, tinnitis 4. Painful rash
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15
Q

DDX for bilateral FN palsy?

A
  1. Congenital - Mobius 2. Acquired - Infectious: HIV, syphilis, - Inflammatory: Wegener’s, sarcoidosis - Neuro: Guillain-Barre, pseudobulbar palsy - Cancer: leukemia
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16
Q

DDX for congenital FN palsy?

A

Mobius CULLP Velocardiofacial Chiari malformation Hemifacial microsomia Syringobulbia

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17
Q

What is ionizing radiation?

A

Particles or EM waves with enough energy to liberate electrons from atoms/molecules

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18
Q

What are the different types of ionizing radiation?

A

1) Electromagnetic waves: Xray, gamma rays 2) Particles: electrons, neutrons, protons

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19
Q

What are factors influencing cellular response to radiation?

A

Five Rs REPAIR: cell populations can recover after non-lethal damage (ie fractionation allows for recovery) REPOPULATION: between treatments cells undergo mitosis to repopulate tumor REASSORTMENT: most radiosensitive during mitosis (ie: fractionation allows cells to enter mitosis during recovery) REOXYGENATION: cells more sensitive with high O2 RADIOSENSITIVITY: baseline at which other 4Rs are effective (depends on frequency of cell division, length of time between divisions, lifespan, ie precursor cells - high mitotic rate - very radiosensitive; mature cells - low mitotic rate - radioresistant)

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20
Q

What are the phases of acute radioexposure syndrome?

A
  1. Prodromal: GI sx - nauesa, vomiting, diarrhea 2. Latent: few or no symptoms 3. Main phase: different presentation depend on tissues irradiated…
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21
Q

What are the principles and goals of HN recon?

A

Multidisciplinary Prioritize cure Restore function Immediate recon if possible Protect vital structures Restore form Minimize donor site

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22
Q

Recipient vessels for H and N recon?

A
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23
Q

What is the treatment for rabies exposure? (include doses)

A

Not vaccinated:

Rabies IG x 1 does 20IU/kg (as much as possible SC around wound, remainder IM)

Rabies vaccines 1cc IM (deltoid) on day 0,3,7,14,+28 if immunocompromised

Vaccinated:

No IG

Rabies vaccine 1cc IM days 0,3

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24
Q

What is the origin and insertion of lateral pterygoid?

A

Origin

Superior head: infratemporal fossa.

Inferior head: lateral pterygoid plate

Insertion

Superior head: anterior side of the condyle.

Inferior head: pterygoid fovea

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25
Q

What is the origin and insertion of the medial pterygoid muscle?

A

Origin:

Deep head: medial side of lateral pterygoid plate

Superficial head: pyramidal process of palatine bone + maxillary tuberosity

Insertion:

Angle of mandible

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26
Q

What is the treatment for malignant hyperthermia?

A

Stop offending agent

ACLS protocol

100% O2

Ventilatory support

Dandrolene 2.5 mg/kg IV bolus, then 1 mg/kg q25min

Cooling, IV fluids

Prevent AKI

27
Q

What is the mode of action of accutane?

A

Decrease the size and activity of sebaceous glands

Reduction in propionibacterium acnes

28
Q

What is the antidote to botox?

A

Pyridostigmine

29
Q

What is the interpretation of ABI results?

A
  • > 1 = normal
  • 0.7-1 = mild –> antiplatelet
  • 0.5-0.7 = consult vascular surgery +/- imaging
  • 03-0.5 = urgent consult to vascular sx
  • <0.3 = critical limb ischemia, vascular sx on call
30
Q

What is the non-operative treatment of venous ulcers?

A

Compression

Elevation

DVT treatment

Dressing: absorbant, autolytic, antibacterial

Drugs: pentoxyfilline, diuretics

31
Q

What are the preventative surgical treatment for rheumatoid hand?

A
  • Tenosynovectomy
  • Joint synovectomy
    • Tendon rebalancing
32
Q

What are the advantages and disadvantages of primary gingivoperiosteoplasty?

A

Advantages

  • Decrease need for ABG (60%)
  • improved positioning of max segment

Disadvantages

  • poor alignment
  • poor quality bone
  • damage to tooth bunds
  • constricted arch
33
Q

What is the classifcation of operative wounds and the infection risk?

A

· Clean (<2% SSI risk): Non-traumatic wound with no inflammation; no breach of Resp, GI, or GU tract

· Clean-contaminated (4-10%): Non-traumatic wound with minor break in technique; Resp/GI/GU tract entered with minimal contamination

· Contaminated (15-20%): Fresh traumatic wounds; Major break in sterile technique; Non-purulent inflammation encountered; Gross spillage from GI/GU tract

· Dirty (30-40%): Traumatic wound from dirty source; Gross contamination; Purulent infection

34
Q

What are the X-ray findings in camptodactyly?

A
  • flattening of dorsal head PP
  • exaggerated recess at neck of PP
  • volar beaking of MP
  • joint space narrowing
35
Q

What is the ddx for camptodactyly?

A
  • trigger finger
  • pterygium syndrome
  • beal’s syndrome
  • marfan’s
  • arthrogryposis
  • boutonniere
36
Q

Syndrome associated with macroglossia?

A

NF
Beckwith-Wiedermann

Down’s

Congenital hypothyroidism

mucopolysaccharidosis

37
Q

What are 3 functional goals of alveolar bone graft?

A

Bony suport for eventual erupting teeth

Closure of alveolar oro-nasal fistula

Creates stable maxillary dental arch

Facilitate eventual odontontic mouvement

Provide nasal base support

Improved oral hygiene

38
Q

What are 5 differences between pediatric and adult facial fractures?

A
  • Faster bony healing
  • Disruption of growth centers
  • Unerupted tooth buds decrease strength and compliance of facial skeleton
  • Bone has greater cancellous to cortical ratio and more elastic and resistant to fracture
  • Absent or underdeveloped sinuses may predispose to cranial base fractures
38
Q

What are hte advantages of primary alveolar bone grafting?

A
  • Early closure of alveolar nasal-oral fistula
  • Decreased orthodontic and orthognathic treatment due to better bone growth and bone stock
39
Q

Rank transplant tissues from MOST to LEAST antigenic?

A
  1. Skin, mucosa
  2. Muscle
  3. SubQ tissues
  4. Bone (bone marrow)
  5. Cartilage, tendon, vessel
40
Q

How is tolerance achieved?

A
  1. Immunosuppression
  2. T-cell anergy
  3. Cytokine pattern alterations
  4. Immunoregulatory cells
41
Q

When should patients stop smoking?

A

4 weeks prior (SR 2012)

42
Q

What are 4 features of carpenter syndrome? Which gene and chromosome?

A

Features: synostosis, flat nasal bridge, low-set ears, symbrachydactyly, preaxial polydactyly

Genetics: AR, RAB23 on chromosome 6

43
Q

What is the mechanism of Rivaroxaban (Xarelto)? What is the reversal agent?

A

Direct factor Xa inhibitor

Direct factor Va inhibitor

Reversal agent: Andexxa, FFP

44
Q

What is the preoperative workup for malignant hyperthermia?

A

Caffeine-halothane contracture test

Piece of skeletal muscle is excised, ryanodine receptor exposed to halothane and/or caffeine

Abnormal contractile activity = susceptible

45
Q

How to avoid cardiac arrhythmias in phenol peels?

A
  • Continuous cardiac monitoring
  • 30 minutes after procedure
  • Space out application of phenol to each unit
  • IV fluids
  • Diuresis (lasix 20mg) 10 min before application of phenol (?)
46
Q

What is the sequence of eruption of permanent teeth?

A

First molars 7 years

Median incisors 8

Lateral incisor 9

First premolar 10

Second premolar 11

Canines 11 to 12

Second molars 13 to 14

Third molars 17 to 40

47
Q

Which gense are associated with the following syndromes?

  • Saethre-Chotzen
  • Apert
  • Crouzon
  • Pfeiffer
  • Muenke
  • craniofrontonasal syndrome
A
  • Saethre-Chotzen: TWIST1
  • Apert: FGFR2
  • Crouzon: FGFR2, FGFR1
  • Pfeiffer: FGFR 2
  • Muenke: FGFR 3
  • Craniofrontonasal syndrome: EFNB1
48
Q

What are the contents of the optic foramen?

A

Optic nerve

Ophthalmic artery

49
Q

What is the pathophysiology of oculocardiac syndrome?

A

Compression of nasociliary nerve which gives signal thorugh the reticular formation to the vagus nerve

50
Q

What are the contents of the SOF?

A
  • CN3,4,6
  • V1: NFL (nasociliary, frontal, lacrimal)
  • Lazy (lacrimal) French (frontal) Tarts (Trochlear) Sit (superior oculomotor) Naked (nasociliary) In (inferior oculomotor) anticipation (abducens)
  • Parasympasynmethic to pupil
  • Recurrent meningeal artery
  • Superior ophthalmic vein
51
Q

What are the contents of the IOF?

A
  • inferior ophthalmic vein
  • V2 infraorbital zygomaticotemporal zygomaticofacial sphenopalatine
  • Infraorbital orbital artery
52
Q

What is the clinical triad of oculocardiac reflex?

What is the treatment?

A

Triad: bradycardia, nausea, syncope

Treatment: antiemetic, atropine 0.5mg IV, urgent release of ST structures

53
Q

What are indications for urgent management of orbital fractures?

A
  • White eye blow out
  • Entrapment
  • Retrobulbar hematoma
  • Blow in fracture
  • Oculocardiac reflex
54
Q

What are the clinical findings in enophthalmos?

A
  • Superior sulcus defomrit
  • Supratarsal hollowing
  • Hypoglobus
  • Diplopia
55
Q

What is a white eye blowout fracture?

A
  1. Discrete evidence of fracture on imaging studies
  2. restriction in ocular motility
  3. minimal to no soft tissue trauma, hence the term “white-eye”
56
Q

What are the principles of orbital floor management?

A
  • Reduce entrapped structures
  • Replace orbital contents
  • Restore orbital volume
  • Get ophtho consult
57
Q

When is coercion OK?

A

Therapeutic privilege - when MD can withhold information if believes that patient may be unable to cope with explanations (i.e.: delirious patient after cholecystectomy wants to revmoe her IVs and go home)

58
Q

What is the percentatge of occult breast cancer discovered incidentally at time of breast reduction?

A

5% - symmetry after mastectomy

0.4% - macromastia

59
Q

Difference between mechanical and biologic creep?

A

Mechanical: elongation of skin with a constant load over time beyond intrinsic extensibility

Biologic: generation of new tissue due to a chronic stretching force

60
Q

When can you breach confidentiality

A

Serious danger of bodily harm or death

Danger is imminent

Risk to specific persons or groups

Commucable disease

61
Q

What are risk factors for dry eyes?

A

Proptosis/exophthalmos

Poor bell’s reflex

Contact lenses intolerance

Lower lid hypotonia

Negative vector

62
Q

Bones of the nasal septum?

A

PRS RC 2020 (6 decks)

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