SCORE Flashcards
Pt has a 50% TBSA 3rd degree flame injury with soot in the sputum. Serum carboxyhemoglobin is 30%. The PaO2 is 150 torr (FIO2 1.0) after intubation. the next step in management is?
Initiate low tidal volume ventilation. Pts with 50% TBSA are at risk of sustaining complications related to resuscitation, so a hyperbaric chamber is not appropriate. With a PaO2/FiO2 ratio <200, they have significant lung injury and are at risk for ARDS. ventilation with low tidal values allows for hypercapnia, the low volume/high frequency ventilation tolerates a respiratory acidosis to keep intrathoracic pressures below 40cm H20 and decrease barotrauma
what 2 bugs are associated with lymphangitis?
staph aureus and strep pyogenes
what is sepsis?
a life threatening organ dysfunction due to dysregulated response to infection
what is qSOFA?
a combination of 3 abnormalities: hypoTN, inc RR, AMS
what is septic shock?
HypoTN in which you need pressors to maintain a MAP <65mmHg AND elevated serum lactate >2mmol/L
What is Light’s Criteria?
Exudative Effusions will have a pleural fluid protein/serum protein>0.5. Pleural fluid LDH/Serum LD>0.6. Pleural fluid LDH > 2/3 the upper limit of serum LDH normal
what is the best means of diagnosis of an Empyema?
CT
Does intraoperative cholangiograms reduce the risk for biliary ductal injury?
No
Most common approach for resecting atrial myxomas
Median Sternotomy and L and R atriotomies
Most common cause of adrenal insufficiency is…
autoimmune disease
How to treat H. Pylori?
Clarithromycin, Amoxicillin, and a PPI (omeprazole). Metronidazole can be used in a penicillin allergy
Risk factors for the development of pseudoaneursym following peripheral arterial intervention
- larger sheath size 2. heavily calcified arteries 3. obesity 4. need for concurrent anticoagulation 5. combined arterial and venous puncture 6. inadequate post catheterization compression
what is the vicious triad in acute coagulopathy of trauma and shock?
hypothermia, acidosis, clotting factor consumption
What are the zones of the neck?
I-below the cricoid to the level of the clavicles
II-between the cricoid to the angle of the mandible
III- Above the angle of the mandible to the base of the skull
Which of the follow is not an indication for liver transplantation?
Colon Cancer
what is associated with sodium warfarin-induced skin necrosis?
Protein C deficiency
What does Gastric tonometry measure
lumin PCO2
where does lymphatic drainage of the testes follow?
R: paracaval and interaortocaval lymph nodes
L: para-aortic lymph nodes
what injury is common in L nephrectomy?
Pancreas
what is the cutoff function for nephrectomy?
15-20%
Pt is undergoing a laparotomy for hysterectomy. She is having massive pelvic hemorrage, which has not been controlled. How do you control the bleeding?
ligation of the hypogastric artery, anterior branch (internal iliac) - will reduce pulse pressure to the pelvis. Collaterals will provide flow to prevent necrosis. AVOID the posterior branch, decreased collaterals.
how do you improve patient survival rate in ovarian cancer?
operative debulking: disease, TAH, bl salpingooophorectomy, omentectomy
Gastrinomas are most often found where?
In the gastrinoma triangle: R of the superior mesenteric vessels (cystic and common bile ducts), head of the pancreas, duodenal wall (2nd and 3rd portions)
MEN 1 syndrome
Parathyroid, Pancreatic tumor, Pituitary tumor
MEN IIa
Medullary thyroid cancer, pheochromocytoma and parathyroid tumors
MEN IIb
Medullary thyroid cancers, pheochromocytomas, marfinoid habitus and mucosal neuromas
in asymptomatic relatives of patients with MEN IIa, risk of medullary carcinoma can be assessed how?
Identification of a RET proto-oncogene mutation- MEN 2 is a gain of function autosomal dominant gene.
what is a risk of doing an interscalene block?
hemidiaphragmatic paralysis due to accidental phrenic nerve block
what are the sx of a myxedema coma?
hypothyroidism, hypocortisolemia, hypoventilation, hypothermia, hyponatremia, hypotension, hypoglycemia, and infection
what do you use each biostats test for?
- wilcoxon test
- paired t-test
- Kruskal-Wallis test
- Linear regression
- wilcoxon test- relationship between orindal variables (satisfactions scores in before/after treatment), or comparing baseline age participants
- paired t-test - continuous data
- Kruskal-Wallis test - ordinal data from three or more groups
- linear regression studies are for the association between 2continuous variables
Genes are associated with which thyroid cancer?
- RET mutation
- PAX8/PPARgamma
- p53
- BRAF-V600
- familial medullary thyroid carcinoma
- follicular thyroid cancer
- anaplastic thyroid cancer
- papillary thyroid carcinoma
what are ordinal variables?
have 2+ categories that are ranked - ex. pt asked to express pain level from 1-10
what is the other name for the Wilcoxon rank-sum test?
Mann-Whitney U Test
what do you administer to help reverse local anesthetic toxicity?
IV Intralipid
which is correctly paired?
- Cohort study - odds ratio
- Case control study - odd ratio
- Case control study - relative risk
- Randomized controlled trial - odds ratio
- Case control study - odds ratio
when disease incidence increases, what happens to positive predictive value and negative predictive value?
PPV will increase and NPV will decrease
An investigator is finding an associationg between exposure to a toxin and gastric cancer. She sends a survey to 1000 pts with the disease and 1000 pts without the disease. what sort of study is this and what statistical measure should be reported to summarize the findings?
case-control study - cases are selected on whether someone has the disease or not. Odds ratio
which non-depolarizing relaxants is preferred in intubation of patients with hepatic or renal dysfunction?
atracurium
what does secondary analysis mean?
analyzing existing data that has been collected to answer a different research question
Renal Injury Scale in Trauma
I-V
I-Contusion with microscopic or gross hematuria, hematoma that is subcapsular and nonexpanding
II- Hematoma that is perirenal but confined to renal retoperitoneum. Laceration <1cm parenchymal depth without extravasation.
III- laceration >1cm without extravasation
IV- Parenchymal laceration extending through the renal cortex, medulla, and collecting system. Main renal arter or vein injury
V-Avulsion of the renal hilum and completely shattered kidney
which classification of renal injuries do NOT need to be operated on?
I-III
what is the maximum safe dose of Lidocaine with Epi? Without Epi?
Lido with Epi = 6-7mg/kg
Lido WITHOUT Epi = 4-5mg/kg
what is the reversal agent for rocuronium?
a chelating agent, sugammadex. Or in general, a cholineesterase inhibitor (eg. neostigmine) can be given to inc the amount of AcH
What happens to the HR, SV, MAP, and SVR during pregnancy?
HR inc, SV inc, MAP dec, SVR dec
what is an absolute contraindication to methotrexate
breastfeeding
which anticoagulant should be started for a pt that has a DVT on POD5?
LMWH
what is the maximum exposure that a pregnant woman can have?
5 rad (0.05 Gy)
what is the apology law and which state doesn’t have one?
Where “Im sorry” statements or expressions are not admissible in court. New York
how do you reverse dabigatran?
Idarucizumab - a monoclonal antibody to dabigatran
what is the average amount of radiation that a fetus receives during a CT scan?
2.5 rads
which pain medication has a “black box warning” for post tonsillectomy/adenoidectomy?
codeine
Cardiac Ejection Fraction is falsely increased in which two heart conditions?
mitral insufficiency and ventricular septal defects
name 6 proserotenergic opoids?
fentanyl, methadone, meperidine, tramadol, dextromethorphan, and propoxyphene
what is the best reversal for warfarin?
four factor prothrombin concentrate - includes factors II, VII, IX, X
what occurs during refeeding syndrome?
insulin secretion, hypoK, hypoCa, hypoPhos
What is the operation of choice for an injury of the proximal biliary tree?
Roux-en-Y hepaticojejunostomy
what is cholesterolosis in the gallbladder?
multiple cholesterol polyps (cholesterolosis) typically are pedunculated, hyperechoic, and do not have posterior shadowing
when do you perform an ERCP with stone extraction and sphincterotomy?
when the patient is in septic shock (probably in the ICU) and cannont tolerate any procedure that would require a laperotomy (CBD exploration, choledocoenterostomy, biliary T tube placement).
Why do you see Prolong PT in pts with CBD obstruction?
The biliary obstruction deprives the SI of the bile necessary to break down fats and absorption of fat soluable vitamins, specifically vitamin K which is a cofactor for factors VII, IX, X
Which test would be a good reproduction of biliary colic as well as identify if a patient would benefit from transduodenal sphincteroplasty?
Morphine - neostigmine (Nardi) test. Used to identify sphincter of Oddi dysfunction by Morphine contracts the sphincter and neostigmine contracts the biliary system