True Learn assessment 1 Flashcards
What dose of Prednisone is considered low risk for adrenal insufficiency?
<5 mg/day Prednisone or its equivalent for any duration or <3 weeks for ANY dose
No additional stress dose of steroid is necessary
At what dose do you have to worry about stress doses of steroids?
> 20 mg/day of Prednisone for 3 or more weeks with Cushingoid appearance (assumed HPAA suppression)
Cont home dose the morning of surgery (regardless type of surgery) and give additional dose if undergoing moderate to major stress surgery
What dose of Prednisone is considered intermediate risk for HPAA suppression?
5-20 mg/day of Prednisone (or its equivalent) for 3 or more weeks
Should undergo preoperative evaluation for HPAA suppression and need for stress steroids with moderate to major stress surgery
How do you treat a patient on 5-20 mg Prednisone/day (or more) for minor/ambulatory surgery? (local anesthetic, inguinal hernia, hand surgery, colonoscopy)
take normal AM dose, no stress dose
How do you treat a patient at risk for HPAA suppression undergoing MODERATE STRESS surgery (lower extremity revascularization)?
Take normal AM PO dose day of surgery
Before induction give hydrocortisone 50 mg IV
POD 0-2: hydrocortisone 50 mg every 8 hours for 24 hours (or until can take PO)
POD 2: reduce hydrocortisone to 25 mg every 8 hours (if NPO) or PO prednisone 15 mg once a day or prep steroid dose (whichever is higher)
POD 3-4 outpatient dose
How do you treat a patient at risk for HPAA suppression undergoing high stress surgery (major cardiac, abdominal, thoracic)?
Take normal AM PO dose day of surgery
Before induction give hydrocortisone 100 mg IV
POD 0-2: hydrocortisone 50 mg every 8 hours (or until can take PO)
POD 2: reduce hydrocortisone 25 mg every 8 hours (if NPO) or PO prednisone 15 mg once a day or prep steroid dose (whichever is higher)
POD 3-4 PO outpatient dose
How dose heparin work?
Augments a native anticoagulant
Activating antithrombin III directly which inactivates both thrombin and activated Factor Xa (inhibits coagulation)
Has a pentasaccharide sequence that is essential for binding antithrombin III
How does LMWH work?
Augments naturally occurring anticoagulation in the body
Shorter molecule than heparin - still has pentasaccharide sequence - it inactivates Factor Xa but not thrombin
How dose Warfarin work?
inhibits production of vitamin K dependent factors of coagulation (II, VII, IX, X), factors C & S
inhibits vitamin K epoxide reductase complex 1
How does Argatroban work?
Direct binding of thrombin and inhibition of its activity
What is the best initial test for Budd Chiari syndrome?
Duplex US of the liver
If a hypothermic patient undergoes arrest, what vitals do they need to have before stopping ACLS?
warmed to 32 degrees celsius
or serum potassium is greater than 12 mmol/L
Duodenal atresia and annular pancreas is commonly associated with what?
Down’s syndrome
what one thing is associated with jejunal intestinal atresia?
cystic fibrosis ~10% cases
what is the MOA of magnesium sulfate?
Competitively inhibits calcium channels
can be used as a tocolytic or seizure prophylaxis in pre-eclampsia
Has similar efficacy as Terbutaline with fewer side effects
The 3 year survival rate for patients w/IPMN with high grade dysplasia following surgery is?
75%
BD-IPMN can be monitored with serial imaging if?
less than 3 cm and no concerning features
How does Calcitonin work?
opposes PTH and decreases calcium levels
increases phosphorous excretion in the kidney
What is this?
Perianal condyloma acuminata (genital warts)
Most common STD seen in colorectal surgery office
Condyloma acuminate is caused by what?
HPV 6 and 11
HPV 16 and 18 can be more aggressive and progress to dysplasia or carcinoma
What is the treatment for condyloma acuminata
Remove macroscopic disease
Recurrence is extremely high
topical agents can be used as adjunts
acute adrenal insufficiency (Addisonian crisis) presents with what symptoms?
fever, abdominal pain, vomiting, hypotension
Cowden syndrome is associated with what genetic suppressor gene
PTEN
What is the most important risk factor for development of heart failure?
CAD
What kind of colostomy has the highest risk for parastomal hernia?
end colostomy
which nosocomial iatrogenic healthcare infection is most likely to cause mortality?
Pneumonia
what is the most common nosocomial infection?
UTI
How is pancreatic insufficiency diagnosed?
fecal fat testing
What is the screening for BRCA patients <30 years old
annual breast MRI
what is the screening for BRCA patients 30-75 years old?
annual breast MRI and mammogram
What can you give for antithrombin III deficiency?
FFP
When is cryoprecipitate used?
treating factor deficiency (hemophilia A), Von Willibrand Disease, hypofibrinogenemia, may help with uremic bleeding
When is FFP used?
replace labile factors in patients with coagulopathy and documented factor deficiency like ATIII deficiency
has factors V, VII, IX, X, XI, protein C and S, plasminogen or antiplasmin
DOES NOT have factor VIII or vWF
What are some indications to do a deep inguinal lymph node dissection for melanoma?
positive Cloquet’s node (most superior superficial node),
multiple superficial nodes are positive, or imaging that suggest deep ilioinguinal metastatic disease
What is the contraindication for a VRAM flap?
prior c section or ex lap
why is a VRAM flap not a good idea after a superficial inguinal node dissection?
the ipsilateral inferior epigastric artery is ligated when the nodes are removed so you have to take the contralateral inferior rectus
what is the flap of choice after a superficial inguinal node dissection for melanoma?
Sartorius flap
what is the most effective non-surgical treatment for achalasia?
pneumatic dilation
