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Surgical Foundations > Review Week Questions > Flashcards

Review Week Questions Flashcards

1
Q

amide local anaesthetics

A

lidocaine
bupivacaine
ropivicaine
mepivicaine

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2
Q

ester local anaesthetics

A

benzocaine
tetracaine
procaine
cocaine

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3
Q

mechanism of action of local anaesthetics

A

Na+ channel blockers to shut down action potential propagation

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4
Q

which local anaesthetics have the fastest onset?

A

those with a pKa closest to physiological pH (7.4)

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5
Q

which local anaesthetics have the longest duration of action?

A

those with highest protein binding

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6
Q

which local anaesthetics are most potent?

A

those with highest lipid solubility

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7
Q

which locals have more allergy?

A

esters

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8
Q

which locals are more toxic?

A

amides

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9
Q

fastest onset locals?

A

esters

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10
Q

longest duration

A

amides

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11
Q

longest acting locals

A

ester - tetracaine

amide bupivicaine

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12
Q

what does 1% concentration mean regarding locals?

A

well, 1g in 100mL is 1%

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13
Q

max dose bupivacaine and ropivacaine

A

3 mg/kg

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14
Q

max dose lidocaine

A

4.5 mg/kg (7 mg/kg epi)

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15
Q

early signs of local anaesthetic toxicity

A

perioral numbness
light-headedness
visual and auditory hallucinations
muscle twitching

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16
Q

late signs of local anaesthetic toxicity

A 
unconsciousness
convulsions
coma
respiratory arrest
cardiovascular collapse
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17
Q

specific toxicity of cocaine

A

sympathomimetic

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18
Q

specific toxicity of benzocaine

A

methemoglobinemia

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19
Q

specific toxicity of bupivacaine

A

cardiac

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20
Q

specific toxicity of prilocaine

A

methemoglobinemia

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21
Q

specific toxicity of ropivacaine

A

less cardiac toxicity than bupivacaine

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22
Q

specific toxicity of lidocaine

A

myocardial depression and vasodilatation

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23
Q

down side of regional anaesthetic

A

local toxicity

neuropraxia

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24
Q

when do you prefer spinal?

A

uro
perinela
low abdominal
extremity

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25
Q

complicatons of spinal

A

hypotension, bradycardia, epidural hematoma, urinary retention, backache, infection, respiratory distress, post-dural puncture headache, cardiac arrest

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26
Q

absolute contraindications of spinal

A 
sepsis
bacteremia
cellulitis
hypovolemia
coagulopathy
theraeutic AC
increased ICP
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27
Q

when would you use epidural?

A

thoracic
abdominal
extremity

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28
Q

how long must you wait before restarting DOAC after pulling epidural?

A

6 hours (wait 3 days prior to starting one)

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29
Q

how long must you wait before restarting warfarin after pulling epidural?

A

depends on INR (7 days pre)

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30
Q

how long must you wait before restarting LMWH after pulling epidural?

A

12 hours (12 hours pre)

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31
Q

how long must you wait before restarting UFN after pulling epidural?

A

1 hour (4-6 hour pre)

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32
Q

how long must you wait before restarting antiplatelet after pulling epidural?

A

immediately (5-7 days)

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33
Q

favoured induction agent for children

A

inhalation agents

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34
Q

agent in anaesthesia that crosses over with egg or soy allergy

A

propofol

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35
Q

effect of propofol on cerebral perfusion pressure

A

decreases it

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36
Q

when should etomidate be avoided?

A

adrenal insufficiency

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37
Q

induction dose of propofol

A

1 to 2.5 mg/kg

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38
Q

induction dose of etomidate

A

0.15 to 0.3 mg/kg

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39
Q

induction dose of ketamine

A

1 to 2 mg/kg

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40
Q

increasing MAC of common anaesthetic agents

A 
halothane 0.8
isoflurane
enflurane
sevoflurane
desflurane
NO
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41
Q

key difference between depolarizing and non-depolarizing anaesthetics

A

blocking versus release of acetylcholine

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42
Q

metabolism of curoniums

A

hepatorenal, plasma (atracuruium)

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43
Q

how can you reverse a curonium?

A

suggamadex truely

neostigmine slowly

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44
Q

metabolism of succinylcholine

A

plasma cholinesterase

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45
Q

contraindication to succinylcholine

A 
K > 5.5
open globe injury
closed head injury
3rd degree burns
paraplegia
pseudocholinesterase deficiency
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46
Q

when would you do pre-op urine test?

A

urological procedure
symptomatic
prosthetic implant

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47
Q

when would you do pre-op fasting glucose?

A

endocrine, renal or hepatic disorder

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48
Q

pre-op ECG?

A

known cardiac risk factors or cardio/resp disease

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49
Q

pre-op CXR?

A

smoker
COPD
recent URTI
cardiac disease

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50
Q

what are the 6 points in RCRI for pre-op cardiac risk?

A 
Hx ischemic 
Hx CHF
Hx CVA
use of insulin
Cr > 177
high-risk surgery
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51
Q

what is a high-risk surgery according to RCRI?

A

anything with a vessel

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52
Q

when should you do post op serial troponins?

A

in anyone >64 or those with significant disease

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53
Q

how do you manage ACE/ARB perioperatively?

A

hold 24 hours prior, start on POD 2

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54
Q

how should you manage ASA perioperatively

A

hold 3 days prior and wait until risk of bleeding from surgery is gone

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55
Q

how should you handle a patient on steroids perioperatively?

A

minor = 25 mg hydro
moderate = 50 hydro
severe = 100 hydro
critical illness = 100 hydro q6

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56
Q

how should you manage hypothyroid during surgery?

A

if elective = postpone

if urgent = give levo and operate

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57
Q

how is ventilation adjusted intraop for COPD?

A

need a prolonged expiratory phase

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58
Q

triggers for MH

A

succinylchline and all volatiles

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59
Q

Tx MH

A

O2
cooling
dantrolene

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60
Q

Tx lidocaine toxicity

A

midazolam

lipid emulsion

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61
Q

genetics of MH

A

AD
ryanodine receptor
1:12,000 kids
1:40,000 adults

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62
Q

what does dantrolene do?

A

binds ryanodine receptor thereby decreasing free intracellular calcium

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63
Q

fentanyl odd side effect

A

serotonergic

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64
Q

when would you use odds ratio instead of relative risk?

A

if prevalence is low

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65
Q

what do you need to calculate NNT?

A

absolute risk reduction

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66
Q

what is variance?

A

the average value of the squared difference between the measurement and the mean

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67
Q

how do you avoid type 1 error?

A

low p value

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68
Q

how do you avoid type 2 error?

A

increase power (sample size)

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69
Q

3 components of power

A

sample size
significance level
effect size

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70
Q

how do you compare means

A

ANOVA

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71
Q

what does bonferroni do?

A

accounts for multiple comparisons

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72
Q

what does chi squared do?

A

tests whether tow categorical variables forming a contingency table are assoicated

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73
Q

what does fischer test do?

A

small sample sizes in categorical variables

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74
Q

how do you compare survival curves?

A

log rank test

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75
Q

what is equipoise?

A

that uncertainty exists over the optimal course of action

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76
Q

which studies should use relative risk?

A

cohort

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77
Q

which studies should use odds ratio

A

case control

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78
Q

layers of the skin

A 
corneum
lucidum
granulosum
spinosum
basale
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79
Q

life cycle of a keratinocyte

A

28 days

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80
Q

mediator of burn swelling

A

histamine

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81
Q

4 stages of burn care

A

eval and resus
wound excision and biological closure
definitive wound cover with reconstruction of hands and face
rehabilitation

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82
Q

arterial carboxyhemogobin > 15%

A

airway burn

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83
Q

inhibition of cytochrome oxidase

A

CN poisoning

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84
Q

persistent lactic acidosis with ST elevation after burns

A

CN poisoning

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85
Q

Tx CN poisoning

A

NaThSO4, hydroxycobalamin and 100% O2

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86
Q

3 stages of pulmonary injury after burn

A

acute pulmonary injury
pulmonary edema (2 days)
bronchopneumonia (25 days)

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87
Q

what is the parkland formula?

A

4 * kg * %TBSA = mL

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88
Q

urine output goal in burns

A

30mL/hr in adults

1-1.5mL/hr in children

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89
Q

what is the parkland adjustment for inhalation burns?

A

add 2 * kg * %TBSA

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90
Q

what is a 3rd degree burn?

A

epi and dermis

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91
Q

when should you refer to a burn centre?

A

hands, face, feet, genitals, joints
third degree
>10% BSA (2nd degree)

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92
Q

what else do you give initially for burns?

A

tetanus

NO Abx!

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93
Q

what is the difference between partial and full thickness skin grafting?

A

partial means part of the dermis

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94
Q

Tx 1st degree burns

A

topical agents (like silver sulfadiazone BID)

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95
Q

contraindications to topical silver sulfadiazine

A

pregnancy
breast feeding
ocular proximity
signs of re-epithelialization

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96
Q

what is mafenide?

A

used in burns - carbonic anhydrase inhibitor
excellent penetration of eschars
can cause metabolic acidosis

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97
Q

which amino acid supplement decreases infectious complications from burns

A

glutamine

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98
Q

how do you supplement burns >40%

A

H-B equation

age, gender, weight, height

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99
Q

how do you supplement burns <40%

A

curreri formula 25kcal/kg/d + 40 kcal/%TBSA/d

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100
Q

complication of using NaCl in burn resus

A

hyperchloremic acidosis

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101
Q

how is most CO2 transported in the blood?

A

as bicarb

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102
Q

level of carboxyhemoglobin in a smoker

A

10-15%

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103
Q

when should you use hyperbaric O2 for CO poisoning?

A 
>25%
>20% and pregnant
LOC
metabolic acidosis <7.1
end organ ischemia
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104
Q

epinephrine

A

B1, B2

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105
Q

norepinephrine

A

B1, A1

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106
Q

dopamine

A

B1, B2

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107
Q

dobutamine

A

B1 > B2 > A1

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108
Q

isoproterenol

A

B1, B2

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109
Q

normal CVP

A

0-6

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110
Q

normal PCWP

A

6-12

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111
Q

normal SVR

A

800-1400 dynes

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112
Q

so how do you measure CVP?

A

at the end of expiration by transducer at the level of the RA

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113
Q

where do you measure PCWP?

A

3rd zone of lung

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114
Q

reverse trendelenberg does what to CO?

A

decreases it

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115
Q

which post op patients need ICU monitoring?

A 
need for suprarenal aortic clamping
MI < 3 months ago
Poorly compensated CHF
CABG < 6 weeks ago
symptomatic mitral or aortic disease
Unstable angina
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116
Q

contraindication to placement of swan-ganz

A

LBBB

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117
Q

which 2 catheters don’t require full barrier precautions

A

urinary

arterial

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118
Q

why is the subclavian vein avoided?

A

hard to compress

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119
Q

lowest risk of infection

A

subclavian

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120
Q

highest risk of infection

A

femoral

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121
Q

highest risk of thrombosis

A

femoral

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122
Q

highest risk of pneumothorax

A

subclavian

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123
Q

highest risk of arterial puncture

A

IJ, femoral

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124
Q

3 reasons for mechanical ventilation

A

obtunded
inadequate oxygenation
inadequate ventilation

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125
Q

criteria for weaning ventilation

A 
cause resolving
adequate oxygenation (PaO2 >60 FiO2 < .4 PEEP < 5
hemodynamically stable
afebrile
awake and alert
Hb 80-100
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126
Q

predictors of successful weaning of ventilation

A 
RR < 20
VC > 10mL/kg
TV 5-7 mL/kg
minute vent >6-8 L/min
negative inspired pressure > 20-25 cm H2O
PEEP < 5cm H2O
PaO2 > 60
SpO2 > 90 on 40%
normal abg
normal hemodynamics
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127
Q

what type of shunt is ARDs?

A

R –> L

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128
Q

Berlin definition for ARDS

A

acute onset
associated conditions
bilateral infiltrate on PA CXR or CT
PaO2/FiO2 < 200-300 with minimum 5cm PEEP or CPAP
must not be explained by cardiac failure or fluid overload

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129
Q

3 stages of ARDs

A

exudate
fibroproliferative
resolution and recovery

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130
Q

Tx ARDs

A

treat cause
lung protecting pressure and ventilation
non-excessive PEEP
conservative fluid management

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131
Q

4 elements of consent as per healthcare consent act 1996

A

related to treatment
informed
voluntary
not by misrepresentation or fraud

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132
Q

what is ‘informed’ consent?

A 
nature of the treatment
benefits
risks
side effects
alternatives
consequence of no treatment
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133
Q

what is ‘capacity’?

A

understand relevant information

appreciate the consequences of the decision

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134
Q

what is a mature minor?

A

any child able to fully appreciate the nature and consequences of the treatment

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135
Q

qualifications of a SDM

A 
capable
16 or older (or the parent)
no separation agreement in place
is available
is willing
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136
Q

hierarchy of SDM

A 
guardian
poa
representative appointed\spouse
child/parent
parent with right of access
sibling
any other relative
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137
Q

when does an advanced directive expire?

A

it doesn’t

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138
Q

so when can you trump an SDM?

A

when you feel they aren’t acting in the best interests of the patient “providing the necessities of life”

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139
Q

eligibility for MAID

A 
eligible for health coverage
18
mentally competent
grievous and irremediable condition
not influenced
informed consent
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140
Q

non-exploitive age of consent

A

16

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141
Q

exploitive age of consent

A

18

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142
Q

age gap allowable for 14/15

A

+5 years

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143
Q

age gap allowable for 12/13

A

+2 years

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144
Q

which should be disclosed?

A

no-harm and harm incidents (not near misses)

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145
Q

4 criteria for negligence

A

duty of care was owed
breech in the standard of care
causation
consequent harm

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146
Q

what do seropositive doctors need to do?

A

get their viral load under 2000 before they operate

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147
Q

plasma % of total body weight

A

5

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148
Q

interstitial fluid % of total body weight

A

15

149
Q

intracellular volume % of total body weight

A

40

150
Q

volume of plasma in male

A

3.5 L

151
Q

volume of extracellular fluid in male

A

14 L

152
Q

volume of interstitial fluid in male

A

10.5 L

153
Q

volume of intracellular fluid

A

28 L

154
Q

what is inside cells

A

K

Mg

155
Q

what is outside cells

A

Na

Ca

156
Q

what is the difference between oncotic and osmotic pressure?

A

proteins versus Na

157
Q

calculate plasma osmolality

A

2*Na + glucose + BUN

normal 290-310

158
Q

normal fluid intake daily

A

2 L (75% from liquid)

159
Q

how much insensible losses occur daily

A

600 mL (75% from skin, 25% from lungs)

160
Q

losses from an open abdomen

A

0.5 - 1 L /hr

161
Q

urine daily

A

800-1200 mL

162
Q

secretion from:
stomach
biliary
pancreas

A

1-2 L
.5 - 1 L
.5 - 1 L

163
Q

K and Na requirement daily

A

.5-1 and 1-2 respectively

164
Q

what controls volume?

A
  1. osmoreceptors in the hypothalamus

2. baroreceptors in the carotid and aortic arch

165
Q

2 most common causes of hyponatremia in a surgical paitent

A

fluid overload

SIADH

166
Q

what is pseudohyponatremia

A

increase in glucose of 10 decreases Na by 3

167
Q

causes of hypernatremia

A

dehydration

DI

168
Q

max correction of Na in
hyper
hypo

A

8/day

0.5-1/day

169
Q

how do you tell the difference between central and nephrogenic DI

A

central improves with DDAVP

170
Q

2 causes of intracellular shift of K

A

meds - insulin, dig, B12, ventolin

hyperthyroidism

171
Q

common cause of hyperkalemia

A

renal failure

172
Q

Tx hyperkalemia

A 
CaGluc
bicarb
insulin
dextrose
kayexalate
dialysis
173
Q

how does acidosis affect Ca

A

decreases the amount bound to protein

174
Q

how does calcitonin affect Ca

A

decreases ionized Ca

175
Q

causes of hypoCa

A 
hypoPTHism
congenital 
hypo Mg
tumor lysis
Vit D intake
pancreatitis
EDTA, citrate, etc
cisplatin, 5FU
176
Q

Tx hypoCa

A

IV CaGluc with Mg

177
Q

signs of hyperCa

A

stones etc

178
Q

causes of hyperCa

A 
primary hyperparathyroidism
malignancy
theophylline
li
thiazide
vit A
milk alkali syndrome
AKI
metabolic alkalosis
179
Q

Tx hyperCa

A 
fluids
diuretic
bisphosphonates
calcitonin
dialysis
180
Q

causes of hyper Mg

A

renal failure
theophylline
antacids
epsom salts

181
Q

Tx hyper Mg

A

CaGluc
NS
diuretics
dialysis

182
Q

diaphragm weakness

A

hypophosphatemia

183
Q

causes of hypophos

A

resp alkalosis
insulin
refeeding
hungry bone syndrome

184
Q

paradoxical aciduria

A

metabolic alkalosis from contraction

185
Q

normal anion gap

A

10-15

186
Q

4 causes of renal failure

A

ATN
AIN
glomerular nephritis
intrinsic renal issue

187
Q

how does FeNa help?

A

it tells you if the kidneys are working <1% means proper resorption is occurring

188
Q

what are the 3 exceptions to FeNa as a valuable test?

A

ATN superimporsed on cirrhosis
after radiocontrast
diuretic use

189
Q

what does acetazolamide do?

A

carbonic anhydrase inhibitor in the PCT - makes you acidotic

190
Q

what does spironolactone do?

A

inhibits aldosterone receptor in CT

191
Q

% of a crystaloid that will remain intravascular

A

~30%

192
Q

why do we avoid ringers in diabetics?

A

lactate can be used for gluconeogenesis

193
Q

2 types of albumin

A

5% or 25% (1 g brings in 18 mL water)

194
Q

so when would you use the 2 different albumins?

A

use 5% for volume expansion
use 25% for oncotic deficit
*do not use in hemorrhagic shock

195
Q

why do we give fluids overnight pre-op?

A

volume expansion because of vasodilatation during surgery

196
Q

normal maintenance fluids

A

4-2-1

197
Q

how do you replace deficit?

A

half in first hour, quarter in the next two hours each

198
Q

quantify third spacing

A

0-2 mL/kg/hr for min surgeyr
2-4 for moderate
4-6 for severe

199
Q

why are salt and water retained after surgery?

A

ADH is released in response to stress

200
Q

when is a good time to use colloids?

A

when the losses are to third-spacing (cirrhosis, etc)

201
Q

5 steps of platelet activation

A 
shape change / vesiculation
degranulation
membrane phospholipid metabolism
membrane flipping
activation of fibrinogen receptors
202
Q

time for NSAIDs to stop affecting platelets after stopping

A

3 days

203
Q

P2Y inhibitors

A

clopidogrel, prasugrel, ticagrelor

204
Q

GP2b3a inhibitors

A

abciximab

tiorfiban

205
Q

phosphodiesterase inhibitors

A

dipyridamole

206
Q

intrinsic pathway

A

12 11 9 10 aptt

207
Q

extrinsic pathway

A

7 10 pt

208
Q

what does thrombin time tell you?

A

fibrinogen deficiency or presence of an inhibitor

209
Q

which factor doesn’t the live produce?

A

VIII (endothelial cells)

210
Q

what is the problem in F5L?

A

protein C cant turn of factor 5 = more clotting

211
Q

what whould you think if a patient failed to respond to heparin?

A

AT3 deficiency

212
Q

clotting and on heparin

A

antiphospholipid syndrome

213
Q

Tx HITTS

A

stop heparin and start a direct thrombin inhibitor (argatroban)

214
Q

when is tranexamic acid contraindicated?

A

DIC

215
Q

when do you transfuse platelets in DIC?

A

<10-20 or 50 with severe bleed

216
Q

antidotes for xabans

A

andexanet alfa

217
Q

antidotes for babigatran

A

idarucizumab

218
Q

what is the tissue factor pathway?

A

TF inhibits VIIa

219
Q

what is the protein C/S pathway

A

thrombin binds thrombomodulin which makes thrombin unavailable, this activates protein C which binds protein S which inhibits Va and VIIIa

220
Q

what is the antithrombin pathway?

A

ATIII inhibits thrombin and Xa

221
Q

would you transfuse an asymptomatic patient with platelets 10?

A

no

222
Q

when do you give platelets to an ITP patient?

A

you don’t

223
Q

Tx TTP

A

FFP

224
Q

what is in cryoprecipitate

A 
fibronectin
fibrinogen
13
8
von willibrand
225
Q

when do you give cryoprecipitae

A

fibrinogen < 1 g/L (adult dose is 10 units or 4 g)

226
Q

are pRBCs acidic or basic

A

actually have a basic result due to bicarb production (even though it is 7.10)

227
Q

what besides blood is in the massive transfusion protocol

A 
replace 1:1:1
TXA q8
fibrinogen above 2
INR < 8
platelets >50 (or 100 with head injury)
228
Q

what is prothrombin complex?

A

2, 7, 9, 10

229
Q

high risk sickle cell surgery

A

exchange transfusion for HbS < 30%

230
Q

moderate risk sickle cell surgery

A

transfuse up to 100

231
Q

how does txa work

A

inhibits plasminogen

232
Q

what is the cell cycle

A 
G1
S
G2
M
G0
233
Q

where does retinoblastoma protein act?

A

negative regulator at restriction point G1-S

234
Q

sequence of events in apoptosis

A

cytochrome C release
caspase activation
DNA frag
apoptosis

235
Q

supraclavicular nodes

A 
breast
neck
lung
stomach
pancreas
236
Q

suspicious axillary node

A

lymphoma
breast
melanoma

237
Q

periumbilical node

A

pancreas

238
Q

where did an ovarian met come from?

A

stomach

colon

239
Q

where did a bone met come from?

A

breast
prostate
MM

240
Q

where did skin mets come from

A

breast

melanoma

241
Q

where did small bowel mets come from

A

melanoma

242
Q

CEA

A

colon

243
Q

AFL

A

liver

244
Q

CA 19-9

A

pancreas

245
Q

CA 125

A

ovarian

246
Q

beta HCG

A

testicular

choriocarcinoma

247
Q

PSA

A

prostate

248
Q

Chromogranin A

A

carcinoid tumor

249
Q

arsenic

A

skin cancer

250
Q

benzene

A

leukemia

251
Q

ethylene oxide

A

lymphoma

252
Q

tamoxifen

A

endometrial

253
Q

epstein barr

A

burkitt’s lymphoma

hodgkins

254
Q

hep B/C

A

HCC

255
Q

HIV and HHV8

A

kaposi’s

256
Q

2 hereditary cancers non AD

A

ataxia-telangectasia

xeroderma pigmentosa

257
Q

RB1 mutation

A

well this is a tumour suppressor so you get
sarcomas
melanomas
CNS tumors

258
Q

Li-fraumeni

A 
bone
soft tissue sarcomas
brain
leukemias
*must get a sarcoma before 45 + first-degree relative with any cancer before 45
259
Q

mutation in 5q21

A

APC

260
Q

other associations with FAP

A

desmoid tumors
papillary thyroid cancer
duodenal adenocarcinoma

261
Q

Lynch syndrome

A

mutation in dna mismatch repair with microsatellite instability
faster progression

262
Q

other associateions with lynch syndrome

A

ovarian

endometrail

263
Q

BRCA mutations

A

5-10% of all breast cancer

264
Q

where is MEN1 located

A

11q13

265
Q

mutation in MEN2

A

RET oncogene

266
Q

10q11 mutation

A

VHL:
hemangioblastomas
RCC
pheos

267
Q

principles of surgical biopsy

A 
will it change anything
obtain enough for pathology
avoid contaminating new planes
avoid hematoma
place needle tracks for later excision
268
Q

border for a 5 mm thich melanoma

A

2 cm

269
Q

alkylating agents

A

crosslink dna
mytomycin
nitrogens

270
Q

taxanes

A

inihibits mitosisvia microtubule dysfunction

271
Q

topoisomerase II inhibitors

A

interfere with dna structure

etoposide

272
Q

platinums

A

crosslink dna

273
Q

anthracyclines

A

inhibit dna and rna syntesis via interecalation of base pairs
inhibit topo
generate free radicals
doxirubicin

274
Q

methotrexate

A

inhibits dihydrofolate reductase

275
Q

tubulin inferers

A

vinchristine

276
Q

what is the typical radiation dose schedule

A

2 Gy/d for 5 days a week for 3-7 weeks

277
Q

tx neurogenic shock

A

phenylephrine (after you’ve Dx with failure of response to fluid)

278
Q

SIRS criteria (need 2)

A 
temp >38 or < 36
>90HR
paco <32
RR >20
WCC >12 or <4
279
Q

cytokine that is antiinflammatory

A 
IL10
IL4
IL13
TGFb
PGE2
280
Q

+ acute phase proteins

A 
ceruloplasmin
fibrinogen
complement F3
CRP
haptoglobin
281
Q

what happens to transferring in inflammation?

A

decreases

282
Q

systemic vascular resistance in sepsis

A

< 800

283
Q

mortality from sepsis

A

20-50%

284
Q

top 2 G+ organisms in sepsis

A

aureus
enterococcus
cag neg staph

285
Q

top 3 G- in sepsis

A

e coli
klebsiella
pseudomonas

286
Q

fluid in sepsis

A

30mL/kg if hypotensive or lactate>4

287
Q

besides abx and fluid, what else decreases mortality in sepsis

A

maintaining glucose between 80-110

maybe low dose steroids (controversial)

288
Q

most likely bug in transfusion-associated sepsis

A

pseudomonas

289
Q

4 early goals of sepsis management

A

MAP > 65
urine output > 0.5
CVP 8-12
mixed venous O2 sat >70%

290
Q

fat/day required

A

1g/kg

291
Q

protein/day required

A

0.8g/kg

292
Q

what is the target kcal/day

A

35 kcal/kg/day

293
Q

calories from fat in starvation

A

40%

294
Q

essential AAs

A

VILL TT PM

295
Q

how much protein for 1 gram of nitrogen

A

6g

296
Q

how much urinary nitrogen is lost daily?

A

1.5% (30% = death)

297
Q

how do we know if we’re eating enough protein?

A

caloric:nitrogen ratio

298
Q

when is the only time you’d want to increase the caloric:N ratio?

A

renal failure

299
Q

carb requirement

A

2-6g/kg/day

300
Q

carb energy conversion

A

1g = 4kcal

301
Q

microcytic anemia

A

copper

302
Q

delayed wound healing

A

vit c

303
Q

impaired glucose metabolism and peripheral neuropathy

A

cr

304
Q

hair loss, dermatitis, decreased taste

A

Zn

305
Q

cardiomyopathy wakness anergy

A

selenium

306
Q

dry flaky skin
alopecia
thrombocytopenia

A

fatty acid

307
Q

vit A

A

poor wound healing

308
Q

megaloblasctic anemia

A

B12 and folate

309
Q

ecg changes

A

biotin

310
Q

coagulopathy

A

vit k

311
Q

slowed collagen crosslinking

A

B6

312
Q

when should you start nutritional support?

A 
anorexic
500mL blood loss
hx severe malnutrition
failure to thrive
catabolic disease
unable to meet their own demands at 7 days
313
Q

time frame for peripheral PN

A

2 weeks

314
Q

how much dextrose is required to spare protein catabolism in PN?

A

100g

315
Q

what should you do with protein for HD pts?

A

increase it to 1.4

316
Q

additional nutritional requirements in burns

A

50%

317
Q

threshold for starting abx in asymptomatic uti

A

100,000

318
Q

3 criteria for qSOFA

A

BP < 100
RR > 22
confusion

319
Q

MAP target in sepsis

A

65

320
Q

dose limit for pregnants

A

4 mSv/pregnancy

321
Q

for nuclear energy worker

A

50 mSv/year

322
Q

public

A

1 mSv/year

323
Q

background radiation

A

2mSv/year

324
Q

what is the worrying dose of radiation in pregnancy

A

0.05 Gy

325
Q

2 cemicals of concern in electrocautery

A

HCN

acrylonitrile

326
Q

nosocomial infection incidence

A

UTI > SSI > resp > central line

327
Q

nosocomial infection incidence in ICU pts

A

VAP > central line > UTI > SSI

328
Q

most infectious BBP

A

HBV

329
Q

PEP regimen

A

NRTI and integrase inhibitor

330
Q

follow up after exposure to HIV

A

6 weeks and 4 months

331
Q

when to start PEP

A

1-2 hours after exposure

332
Q

basiliximab

A

IL2 receptor blocker

333
Q

cyclosporine

A

calceneurin inhibitor

334
Q

tacrolimus

A

calceneurin inhibitor

335
Q

siroloimus

A

mTOR inhibitor

336
Q

mycophenylate

A

inhibitor of IMPDH (purine synthesis

337
Q

azathioprine

A

6MP inhibitor

338
Q

nivolumab

A

blocker of programmed death ligand 1

339
Q

what is PRA

A

panel reactive antibody

340
Q

what are the expanded criteria donor

A

age > 59
age 50-59 with any 2 of: hx hypertension, death from cva, terminal creatinine 133
associated with 70% increased risk of rejection

341
Q

how long should you wait after cancer treatment before you get a new kidney?

A

usually 2 years, 0 if localized and bladder or kidney, 2-5 if melanoma, breast, colon

342
Q

parts of the MELD score

A

creatinine
INR
bilirubin

343
Q

how much liver do you need to leave behind?

A

30%

344
Q

how long do you have to wait before removing organs after cardiac death

A

5 mins

345
Q

at what age is live liver donation contraindicated

A

> 55

346
Q

major cause of mortality after liver transplant

A

infection

347
Q

rejection drug with reduced risk of new cancer

A

sirolimus

348
Q

rejection drug that causes diarrhea

A

mycophenilate

349
Q

indications for traumatic thoracotomy after chest tube insertion

A

> 1.5L immediately or

200mL/hr for 2-4 hours

350
Q

bladder pressure for anuria

A

20mmHg

351
Q

target CPP in brain injury

A

60-80

352
Q

pathological ICP

A

20 or up

353
Q

when do you get autonomic dysreflexia

A

T6 or above

354
Q

tx rhabdo

A

fluids
mannitol
bicarb

355
Q

obtunded definition of compartment sydndrome

A

d < 30

absolute >30

356
Q

what do platelets release in wound healing

A

PDGF

TGF-a

357
Q

what type of collagen is laid down in early wound healing

A

3

358
Q

type 4 collagen

A

basement membrane

359
Q

type 5 collagen

A

cornea

360
Q

abnormal type III, deletion of part of type I, abnormal copper utilization, or deficiency of lysyl hydroxylase

A

ehlers-danlos

361
Q

absence of type VII that is the main component of fibrils that anchor epidermis to dermis

A

epidermolysis bullosa

362
Q

osteogenesis imperfecta

A

deletion on procollagen E1 allele

363
Q

when do you consider antibiotics in wound care?

why?

A

when > 10^5 bacteria per gram of tissue.

because more than this and the wound won’t heal

364
Q

definition of chronic wound

A

3 months

365
Q

3 reasons a wound becomes chronic

A

WBCs release MMPs faster than matrix laid down
protein leak from capillaries binds growth factors
fibroblasts stop responding to normal wound signals

366
Q

when does a pressure ulcer develop?

A

when pressure is > 32 mmHg (capillaries)

367
Q

4 stages of pressure ulcer

A

hyperemia >30 mins
through epidermis
through dermis
into muscle or bone

368
Q

tx venous ulcer

A

hydrocolloid dressing, compression.elevation

Surgical Foundations (1 decks)

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