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SURG > TrueLearn > Flashcards

TrueLearn Flashcards

1
Q

What is the motor scoring system for GCS?

A 
Normal 6
Localizes 5
Withdraws 4
Flexion 3 
Extension 2
None 1
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2
Q

What is the Verbal scoring system for GCS?

A 
5 Oriented (AAO)
4 Confused (responds coherently but some confusion)
3 Verbalizes (no conversational exchange)
2 Vocalizes (sounds not words)
1 None
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3
Q

What is the eye opening scoring system for GCS

A

Spontaneous 4
To command 3
To pain 2
None 1

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4
Q

Severity of TBI based on GCS

A

Mild (13-15)
Moderate (9-12)
Severe (8 or less)

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5
Q

What type of retroperitoneal hematomas must be be explored?

A

All penetrating hematomas
Pulsatile/Expanding hematomas
All Zone 1 hematomas

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6
Q

What type of retroperitoneal hematomas can be safely observed?

A

Non-expanding, non-pulsatile hematomas in blunt trauma in zones II (lateral) and III (pelvic)

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7
Q

For burn patients equal to or greater than 30 kg, to what should UOP be titrated to ensure adequate fluid resuscitation?

A

0.5 to 1 ml/kg/hr

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8
Q

What is most common arrhythmia seen in blunt cardiac injury?

A

Sinus tachycardia

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9
Q

Degree of burn: blanching erythema, painful, no blisters

A

First degree

involve outer layer of epidermis; will slough and be replaced by keratinocytes within 3-4 days of injury

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10
Q

Burn: moist, redness with clear blisters, blanches with pressure

A

Superficial Partial thickness (Second degree)

Papillary Dermis

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11
Q

Burn: dry, yellow or white, less blanching, reduced sensation or insensate

A

Deep Partial Thickness (Second degree)

Reticular Dermis

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12
Q

Burn: leathery, stiff white/brown, no blanching, insensate

A 
Full Thickness (Third Degree)
Full Dermis
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13
Q

Burn: dry, black, charred with eschar

A

Fourth Degree

Extends through entire skin into underlying fat, muscle, bone

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14
Q

Recommended for full thickness burns < 40% BSA due to good penetration through eschar

A

Mafenide

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15
Q

Borders of posterior triangle of neck

A

SCM, trapezius, clavicle

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16
Q

Anterior triangle of neck Zone 1

A

Clavicle to Cricoid

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17
Q

Anterior triangle of neck Zone 2

A

Cricoid to angle of mandible

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18
Q

Anterior triangle of neck Zone 3

A

angle of mandible to skull base

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19
Q

Hard signs requiring exploration in neck trauma

A

crepitus, stridor, hoarseness, tracheal deviation, odynophagia, pulsatile bleeding, expanding hematoma, bruit, thrill

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20
Q

Hard signs of vascular injury

A
  1. Rapidly expanding hematoma
  2. Pulsatile bleeding
  3. Distal Ischemia
  4. Absent Pulse
  5. Bruit or palpable thrill
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21
Q

Soft signs of vascular injury

A
  1. Moderate sized hematoma
  2. Minor bleeding
  3. Associated nerve injury
  4. Decreased pulse
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22
Q

Berlin Criteria (Timing)- ARDS

A

respiratory compromise within 1 week of known insult

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23
Q

Berlin Criteria (Imaging)- ARDS

A

CXR or CT showing bilateral opacities that are not considered effusions, lung collapse, nodules

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24
Q

Berlin Criteria (PaO2/FiO2)- ARDS

A

201-300 Mild
101-200 Moderate
< 100 Severe

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25
Q

Historical Berlin Criteria (PCWP)- ARDS

A

PCWP <18

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26
Q

What tidal volume is recommended in treatment of ARDS patients?

A

Low tidal volume

6 ml/kg

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27
Q

3 Stages of pleural infection

A

1) exudative stage- fluid thin, sterile, low WBC and LDH, glucose > 40 mg/dL
2) fibrin purulent stage- fluid becomes infected and fibrin deposits on pleura, LDH and WBC increase, glucose and pH decrease; fluid thick purulent and lung unable to expand
3) organizing stage- thick pleural peel created by migrating fibroblasts

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28
Q

Common empyema causing organisms

A

Anaerobic organisms much more common than S. pneumo

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29
Q

Tx of pleural infection in organizing stage

A

decortication

30
Q

When is Eloesser flap or Clagett procedure indicated?

A

post-pneumonectomy empyema, allows creation of open wound that permits tissue granulation of empyema cavity

31
Q

Most common cause of exudative effusions?

A

Malignancy

32
Q

Most common cause of transudative effusions?

A

CHF

33
Q

Dobutamine MOA

A

B1 agonist- increase cardiac contractility

B2 agonist- vasodilatory (at higher doses)

34
Q

Post-Op delirium mortality rate is as high as ___

A

40%

35
Q

The duration of post-op delirium affects 6 month mortality by ___% for each day of post-operative delirium

A

17%

36
Q

Cognitive impairment from post-op delirium can last as long as ____ year post-op and up to ____ years in those with dementia

A

1

5

37
Q

How long must you continue CPR in a hypothermic patient?

A

Until core body temperature is rewarmed to at least 30C because vital signs may return with rewarming

38
Q

What causes left shift in oxygen-hemoglobin dissociation curve?

A

increased pH
decreased 2,3 DPG
decreased PCO2
decreased temperature

39
Q

What causes right shift in oxygen-hemoglobin dissociation curve?

A

decreased pH
Increased 2,3 DPG
Increased PCO2
Increased temperature

40
Q

Class I hypovolemic shock

A 
blood loss: up to 750 mL, 15%
pulse rate: < 100 
BP: normal
PP: normal 
UOP: >0.5 mL/kg/hr
41
Q

Class II hypovolemic shock

A 
blood loss: up to 1500 mL, 30%
pulse rate: >100
BP: minimal decrease
PP: narrow 
UOP: >0.5 mL/kg/hr
42
Q

Class III hypovolemic shock

A 
blood loss: up to 2000 mL, 40%
pulse rate: >120 
BP: hypotensive
PP: narrow
UOP: <0.5 mL/kg/hr
43
Q

Class IV hypovolemic shock

A 
blood loss; >2000 mL 
pulse rate: >140 
BP: significantly decreased 
PP: unobtainable/very narrow 
UOP: minimal
44
Q

Tx for post-op Afib in patient without hemodynamic instability

A

IV beta-blockers

45
Q

Tx for post-op Afib in patient with EF < 35%

A

IV amiodarone

46
Q

Two biggest risk factors for gastric stress ulcers

A

prolonged mechanical ventilation >48 hr

coagulopathy (plt < 50K, INR > 1.5, PTT > 2x nL)

47
Q

What is in renal feeding formulas?

A

low intracellular electrolyte concentration
essential amino acids
high calorie to nitrogen ratio

48
Q

Most common presenting symptoms of anaphylaxis

A

urticaria and angioedema

49
Q

According to guidelines, patients without cardiac history who can perform >4 METs require what type of work-up prior to surgery

A

No further work-up

50
Q

What activities are >4 METs

A

climbing flight of stairs
walking up a hills
moderate intensity work-out

51
Q

What is the definition of acute hyponatremia?

A

developed over last 48 hours; treat with hypertonic NaCl bolus (correcting by 4-6 mEq over several hours)

52
Q

Why does chronic hyponatremia have to be corrected slowly?

A

to prevent central pontine myelinolysis

53
Q

How is Atracurium metabolized?

A

non-depolarizing muscle relaxer
Hoffman degradation (temp, pH dependent)
increase in pH favors process; decrease in temp slows process
can be used in patients with liver or kidney failure

54
Q

Sepsis

A

source + 2 SIRS criteria

55
Q

Severe Sepsis

A

Sepsis + organ dysfunction (25-40% mortality)

56
Q

Septic Shock

A

Sepsis with refractory hypotension despite adequate fluid resuscitation (vasoplegia) (40-80% mortality)

57
Q

Treatment for malignant hyperthermia

A 
Dantrolene (act on ryanodine receptor to block Ca release)
Sodium Bicarb (tx acidosis)
58
Q

Normal Cardiac Index

A

2.5 to 4 L/min/m2

59
Q

Normal PCWP

A

4-12 mmHg

60
Q

Normal SVR

A

700 -1600 dynes/sec/cm-5

61
Q

Normal PVR

A

20-130 dynes/sec/cm-5

62
Q

Tx of C. albicans

A

fluconazole

63
Q

Tx of C. krusei

A

Voriconazole

64
Q

Tx of C. glabrata

A

Micafungin

65
Q

Tx of invasive aspergillosis

A

Voriconazole

66
Q

Where in the normal GI tract is the absorption of Calcium the highest?

A

Duodenum and proximal jejunum- highest number of Vitamin D dependent calcium binding proteins

67
Q

Respiratory quotient < 0.7 indicates

A

starvation

68
Q

Respiratory quotient 0.7 indicates

A

pure fat utilization

69
Q

Respiratory quotient 0.8 indicates

A

pure protein utilization

70
Q

Respiratory quotient 0.8-0.9 indicates

A

mixed substrate utilization (desirable)

71
Q

Respiratory quotient 1.0 indicates

A

pure carbohydrate utilization

72
Q

Respiratory quotient > 1.0 indicates

A

overfeeding

SURG (6 decks)

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