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DUGAL ABSITE REVIEW > TRUELEARN > Flashcards

TRUELEARN Flashcards

1
Q

Causes of paralytic ileus (4)

A

opiates, antihistamines, alpha-adrenergic agonists, and anticholinergics.

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2
Q

Trauma patient bleeding out from liver laceration, improved with pringle maneuver. NSM? Assoc complications?

A

Ligate the hepatic artery

Increased risk for hepatic abscess/biloma

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3
Q

Two types of pleural effusions and causes of each?

A

Exudative- increased cap permeability. Large prots escape. (neoplasm)
Transudative- poor balance of osmotic/hydrostatic pressure across pleural memebrane (CHF)

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4
Q

Flail segment 24 hours develops increasing tachy,tachypnea, and increasing O2 requirements?

A

Pulmonary contusions. Supportive care consider intubation

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5
Q

Peripheral axon regeneration growth per day?

A

1 – 2 mm / day (or about 1 inch per month).

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6
Q

how do you diagnose compartment synd

A

clinically with classic sxs

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7
Q

MOST EFFECTIVE Tx for CO posioning

A

Inital tx 100% on NRB mask

BEST tx 100% O2 hyperbaric oxygen chamber

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8
Q

Distal pancreatic body transection. Grade injury? Tx?

A

grade III pancreatic injury, and is best treated by distal pancreatectomy with or without splenectomy.

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9
Q

Indications for CVL? (5)

A

administration of total parenteral nutrition solution, chemotherapeutic agents, hypertonic saline (3% saline) and vasopressor medications. Central venous catheters are also indicated when an appropriate peripheral venous catheter could not be placed (dumb ass med residents)

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10
Q

ABSOLUTE Indication for IVC filter placement (3)

A
  • contraindication to anticoagulation,
  • recurrent thromboembolic disease despite adequate anticoagulation therapy,
  • significant bleeding complications of anticoagulation therapy
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11
Q

Type neck reveals a fracture through the base of the dens, with posterior displacement.

A

Type II dens
requires fusion vs halo. Others (I, III) nonop
check for airway swelling!!

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12
Q

What happens to HR, BP during preggos

A

HR increases 10-15 beats

dec SVR -> dec BP 1st and 2nd trimesters

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13
Q

MCC of pevlic fractures

A

MVC or MCC (50%). MVC vs ped 2nd

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14
Q

HIV + with AIDS MCC of lower GIB

A

CMV

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15
Q

What incisions are required to repair subclavian artery injury R vs L?

A

Left:

  • Proximal control ant thoracotomy 3ICS
  • Distal control subclavicular incis
  • Repair artery via supra clavicular incision

Right:
-median sternotomy

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16
Q

How to rapidly reverse coumadin in bleeding patient requiring emergent surgery

A

PCC plus vitamin K to avoid rebound anticoagulation

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17
Q

%EWL (Excessive Weight Loss) Formula

A

%EWL = weight loss (kg)/excess weight (kg), with excess weight being the difference between actual weight and ideal weight.

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18
Q

Best conduit for lower extremity vascular injuries needing repair?

A

Contralateral reverse GSV

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19
Q

Tx traumatic pancreatic duct transection at body/tail

A

Distal pancreatectomy

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20
Q

TNF a secreted from?

A

Macrophages (principle mediator of inflammation against gram (-) bac

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21
Q

Part of Gram (-) cell wall initates bacterial response?

A

Lipid A (endotoxin). A component of the LPS

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22
Q

what type of collagen is found in a scar?

A

Type I

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23
Q

What do leukotrienes stim macrophages to release?

A

PAF (platlet aggregating factor)

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24
Q

Trauma patient with arm lac. Hypotensive GCS 7 NSM?

A

Intubate (ABC)….then tourniquet

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25
Q

Tx for greater than 50% injury to the intestinal wall circumference?

A

primary resection and anastamosis

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26
Q

Nonop mgmt of spleen in child what constitues failure.

A

1) Unstable

2) OR Tranfusion requirement equal to half blood volume (40ml/kg)

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27
Q

What element forms free radical ?

A

IRON Fe++ in ferrous state

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28
Q

what factors (2) are involved in chemotaxsis and cell prolif during inflammatory response?

A

PDGF and TGF-B from platlets

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29
Q

IAH vs Compartment synd difference?

A

IAH Pressure >=12

Comp syn >20 & end organ dysfucntion

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30
Q

Sentinel Bleeding s/p trach. First step mgmt?

A

Flexible bronchoscopy

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31
Q

Platelet count threshold transfuse to limit spon bleeding?

A

1.0*10^10

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32
Q

tx for postop delirium in elderly

A

haloperidol low dose

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33
Q

MIVF for pediatric pt

A

D5 NS w 20 k

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34
Q

Correction rate of hypernatremia kid Na 160

A

0.5meq/hr 10 mEq

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35
Q

sxs of hypoNa

A

HA, seizure, AMS

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36
Q

Non gap Metabolic acidosis in surgery pt

A

High ileostomy output

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37
Q

When to start EPO in CKD

A

Hbg <10

NOTE: Check Fe stores first!

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38
Q

Mechanism of renal failures in HRS (hepatorenal syndrome)

A

1) Activation of RAS due to systemic hypotension
2) Activation of Symp nervous system 2/2 systemic hypo an increased intrahepatic sinusoidal pressure
3) Decreased vasopression due to systemic hypotension
4. Reduced heaptic clearance of vascular dilators PGE, endothelian etc

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39
Q

Role of Ferritin

A

1) Bind and stores Fe (prevents free radicals)

2) Acute phase reactant (ACD)

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40
Q

CI to liver trn? (3)

A

extraheaptic malig
recent ICH
unfit for operation

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41
Q

MOA of Imuran (azathioprine) and CellCept (mycophenolate)?

A

Inhibit purine synthesis -> growth of T cell

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42
Q

Painful, swollen, fluctuant FINGERPAD!

Vs Nailbed. Dx?

A
  • Felon finger- I&D

- Nail bed is acute paronychia

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43
Q

Why dont we use IFN type I’s anymore for Hep C etc?

A

Wide range of immunomodulation. Can induce or uncover autoimmune disorders. Dirty drug

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44
Q

1 yr % survival living donor kidney trn? 5yrs?

A

97 and 85%

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45
Q

Fight bite pain passive ROM NSM?

A

Surgical drainage for septic arthritis

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46
Q

1st step in pancreatic exposure?

A

open the lesser sac (by incising the gastrocolic ligament)

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47
Q

Suspect what organ injury in child hit handles bars or steering wheel to epigastrium?

A

pancreatic injury

48
Q

(2) Principles of mgmt of pancreatic injuries

A
  1. Identify site of injury relative to neck of pancreas

2. status of pancreatic duct

49
Q

Incision for distal mediastinal tracheal injury?

A

Right thoracotomy

50
Q

Traumatic diapharm injury. Incision and method of repair

A

1) Midline laparotomy,
2) two alices to central tendon of diaphragm
3) primarily close with non-asorbable suture

51
Q

Method of repair two small 2mm close tears of aorta

A

1) Connect tears

2) Primarily repair transervely with polypropalene sutures

52
Q

Pediatric pt mild hypotension and bradycardia. Fluid choice following initial bolus??

A

Blood 10 ml/kg

(brady sign of imepending cardiovascular collpase

53
Q

MCC following pancreatic injury?

A

Fistula, manage with drains high and low output (<200ml/day)

54
Q

Treatment for Zone I RP trauma of ANY kind?

A

Surgical exploration 100% of the time!!

55
Q

What determines mild TBI?

A

Base on GCS NOT CT findings

  • Mild -> GCS 13-15
  • Moderate -> 9-12
  • Severe-> 8 or less
56
Q

stacked rings with linear furrows of esophagus on EGD?

A

Eosinophillic esophagitis

Sxs: Dysphagia for solids, hx of asthma

57
Q

Duration of antibioitcs following surgical source control ie diverticulitis?

A

4-7 days

58
Q

What does adding epi to local do? (2)

A

vasoconstriction-> dec vasc absorption -> inc # of molecules to diffuse to nerve memb.

Results in:

1) increased duration
2) inc density of blockade

59
Q

Best method to confirm ET tube in trachea not esophagus?

A

ET CO2 Monitor.

60
Q

Risk of preop hypothermia

A

Increase risk of infections

Need documented temp >36*C preop

61
Q

What trn drug causes chorea, confusion

A

Prograf (tacrolimus)

62
Q

STSG what is sequence of incorporating?

A

1)Imbebition
2) Inosculation (growing together Tree branches)
3) Revascularization
Process takes about 7 days

63
Q

MC pathogen DM foot infection?

Virulence factor?

A

Staph areus

Collagenase

64
Q

Indication for OR based on tube thoracostomy output?

A

1500ml initially or >200ml/hr for four hours

65
Q

Time to wait after PCI before operating:

1) Angioplasty alone
2) BMS
3) DES

A

1) 2wks
2) 1 month
3) 6 months

66
Q

SCIP periop glucose recommendations

A

NCE SUGAR trial strict control = bad

Keep glucose below 180

67
Q

32 yo F 24 wks with fever, emesis, acute abdominal pain WBC 15k NSM?

A

CT abd/ pelvis

3-4 rads

68
Q

MCC of omental torsion and presentation

A

Patients appear to have perforation, RLQ pain from tumor, hernia, adhesion or inflammation.

Thx is resection of twisted omentum diagnosed intraop most times

69
Q

How is omentum hemostatic

A

Inc amts of TF -> act extrinsic path -> fibrin plug-> adheres omentum in place

70
Q

Peritoneal catheter infection MC bug?

A

Staph epi

Coagulate -negative staphylococci

71
Q

When to start cirrhotic on abx for Primary (spontaneous) bacterial peritonitis? What MC bug?

A

Aerobic enteric flora (ecology, klebsiella)

Start if high risk (bleeding varies or ascitic proteins fluid low <1g, or T bill greater 2.5

72
Q

Diag old lady on BT no trauma acute abdominal pain with palpable abdominal mass unchanged with contraction of rectus muscle. Tx?

A

Rectus sheath hematoma from inferior epigastric artery
Next step CT scan
Manage nonop with serial hbg
Caution!! If below accurate line no aponeurotic post covering to rectus so it can cross midline and cause bilateral lower quad abd pain

73
Q

Treatment for GIST? Most common location

A

Stomach> small bowel/rectum
Imatinib versus resection
Determine recurrence/Tx based on size and mitotic index
Normally don’t biopsy

74
Q 
Apthlous ulcers
Transmural inflammation including submucosa
Longitudinal ulceration
Cobblestoning appearance 
Diag?
A

Crohns

75
Q

Why renal pt at increased risk of DVT

A

CRD increased factor VII and vWF

Nephrotic syndrome dec antithrombin

76
Q

Operating for SMA ischemia best maneuver to isolate SMA?

A

Lift omentum and trans colon cephalad
Retract small bowel to right
Divide ligament of trietz and mobilize duodenum right
Shake hands with root of transverse colon mesenteary to find SMA

77
Q

Common femoral occlusion what artery provides collateral. Flow to leg?

A

Deep circumflex artery (DCA)
DCA and inf epigastric are two branches off Ext illac artery
DCA runs behind inguinal ligament and anastamoses with lateral femoral circumflex to provide flow to leg

78
Q

Intermittent abd pain, jaundice and upper GI bleed? Tx?

A

Hemo bilia Angio

79
Q

Tx for fibromuscular dysplasia HTN 200s?

A

Percutaneous tranluminal angioplasty curative

80
Q

Supparitive thrombophlebitis of PIV site MC. Bug?

A

Staph aureus remove catheter

81
Q

Treatment of anal melanoma

A

WLE equal to APR

82
Q

MEN2A

A

AD RET proto oncogene
MTC, Pheo, Hyperparathyroidism
Ppx Thyroidectomy by age 5

83
Q

Mucinous neoplasm of appendix vs mucinous adenoca?

A

Nonruptured mucinous neoplasm no further workup or screening. DONE

Right hemi for adenoca

84
Q

Heparin bolus, maintenance rate goal PTT for ALI

A

80 units per kg
18””
60-90 sec

85
Q

Anal cancer tx

A

Chemo radiation with nitro protocol

5FU, mitomyocin C and radiation (all stages!)

86
Q

Incidental or six mesenteric cyst tx?

A

Same enucleation, remove risk of local external compression

87
Q

What is location of inslinomas

A

Evenly distributed throughout pancreas

88
Q

Patchy segments of ulceration, erythema and edema throughout colon? Causes?

A

Ischemic colitis= affects arterioles of colon

Consider hypercoag. Infectious, embolic, vasculitis drugs is cocaine

89
Q

Amphotericin B side effects and electrolyte abnormalities

A

Hypo K, Mg. Liver failure

90
Q

Linezolid Side effects?

A

MOA inhibitor do not give with other serotnergic drugs

MOA- DNA synthesis inhibitor

91
Q

Anti-angiogenic factor induced by hypoxia

A

Interferons

92
Q

% Infection risk for contaminated cases?

A

10-17% ie fecal spillage during colectomy

93
Q

what is cushings dz? 1st line tx? 2nd?

A

inc ACTH secreting pituitary adenoma.
Tx:
1 Transphenoidal resection of pituitary 75% success rat. 2. radation
3. bilateral adrenalectomy

94
Q

Nodular submucosal lymphoid hyperplasia on scope. NSM?

A

Assoc with Immunsupression check for HIV test

95
Q

Swimmer with Venous thoracic outlet syndrome. Best initial tx?

A

IV heparin AND thrombolysis

96
Q

45 yo F presents to PCP with HTN, HA, diaphoresis palpitations. Urine metanephrines elevated 24 hours. Diagnosis

A

Danny davito- Pheo

10% extrea adrenal, malignant, bilateral, familial

97
Q

MCC young female renal HTN. Pathological findings?

A

FMD- multifocal fibrodysplasia

Thickening of media and collagen formation

98
Q

Contraindication to clostazol

A

CHF

99
Q

Best test to diagnose cushing syndrome

A

24 hours urine free cortisol

100
Q

Ways to inc length for total proctocolectomy with ileal anal J pouch if pouch under tension? (3)

A

1) Mobilize mesentery to D3, pancreas
2) Divide ileum flush with cecum
3) Steplappder relaxing incisions over the front and back of mesenteric vessels along tension lines (ie SMA)

101
Q

Pt with elevated urine cortisol and elevated ACTH. Next best test to establish diagnosis?

A

Cushing dz.
High dose dexamethasone suppression test.
If suppressed -> Pituitary adenoma
If NOT suppressed -> Ectopic tumor

102
Q

Two things to evaluate prior to reversing ostomy?

A

1) evaluate intraop for other colonic patholgy or malignancy

2) Evaluate intact anal sphincter mechanism contience via

103
Q

Where should IVC filter be placed?

A

Inferior vena cava below renal veins

104
Q

MC gene defect in colorectal cancer

A

APC (gene involved in FAP)

105
Q

MC complication after Whipple? Tx?

A

Delayed gastric emptying

Tx supportive surgery last resort

106
Q

Definition of oncologic resection of colorectal cancer? (Margins, nodes)

A

2-5 cm margin

12 nodes negative

107
Q

Location of gastrinomas vs insulinomas

A

Gastrinomas- passaros triangle mostly duodenum

Insulinomas- evenly distributed throughout the pancreas

108
Q

Criteria for metabolic syndrome

A

Fat + risk factors for stroke, CAD, DM (lower threshold)

Fat-
Males- waist >40
Female >35cm

Risk factors

Glucose >100 fasting or DM
TG>150
HDL <50
Systolic BP >130

109
Q

Where are gastrin secreting cells primarily located

A

Antrum- activate parietal cells to secrete H+
D cells- somatostatin also here

Why Pts with ulcer dz get antrectomy

110
Q

MEN 2A

A

MTC, pheo, 4 gland parathyroid hyperplasia

111
Q

How to differentiate btw parathyroid adenoma and carincoma lab values?

A

Both present with palpable neck mass with sxs of 1* hyperparathroid

Adenoma:
PTH <100 (normal 50)
ca++ 1 meq above normal

Carcinoma
PTH 500s
Ca++ 3-4 above normal (>=13)

112
Q

Why is previous DVT risk factor for venous insufficiency ?

A

Secondary valvular incompetence -> venous reflux on US

113
Q

Parietal vs Visceral periotneum

A

Different blood supplies
Parietal few nerves pain generalized, covers intraabdominal organs
Visceral covers body wall, lots of pain fibers localized

114
Q

Name RP structures

A

SAD PUCKERS
Supradrenal glands
Aorta/IVc
Duodenum (2,3)

Pancreas
Ureters
Colon (ascending and descending)
Kidneys
Esophagus 
Rectum
115
Q

Cause of direct vs indirect inguinal hernia

A

Indirect- patent process vaginalis

Direct- weakness in conjoined tendon

116
Q

Pancoast tumor present with horners. Type of cancer and treatment.

A

NSLC
Tx:
Chemo followed by surgery
Chemo radiation if unresectable

Absolute c/I to surgery:

1) N2 mediastinal or N3 contralateral supraclavicular node
2) distant Mets
3) invasion to trachea, esophagus.
4) >50% vertebral body involvement
5) Brachial plexus involvement above T1

117
Q

Hemoptysis recurrent pneumonia and pink/purple friable mass covered by epithelium

A

Carcinoid- type of neuroendocrine tumor

DUGAL ABSITE REVIEW (1 decks)

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