TrueLearn Pretest Flashcards
Treatment for DVT in pregnancy?
Lovenox > heparin gtt, or SQH.
Flail chest EAST guidelines for pain mgmt?
Epidural analgesia. Improve pain and PFTs compared to narcotics. Less mech vent days, shorter ICU, decrease VAP.
Management of cecal volvulus?
Surgical resection with ileocolonic anastomosis if bowel not gangrenous. Do not decompress endoscopically.
TeamSTEPPS. Team Strategies and Tools to Enhance Performance and Patient Safety?
Systematic approach to integrate teamwork into practice. Introduce strategies for the TEAM.
Failure mode and effects analysis tool?
Forward looking approach - inductive reasoning to figure out what will fail.
Human factors design?
recognize deficient designs that hinder workflow or allow people to bypass safety features. (like making people do a checklist)
PDSA Plan Do Study Act cycle?
Test a change that is implemented.
Where is stress induced gastritis seen?
Linear ulcerations noted in the gastric body and fundus.
Modified JOHNSON peptic ulcer classification?
I. Lower lesser curve
II. Lower lesser and duodenal (acid)
III. Prepyloric (acid)
IV: Higher lesser curve
V. NSAIDs.
Whipple triad?
Insulinoma. Neuroglycopenic sx (dizzy, sz, anx, confusion, personality change), low BG (<45), relief of sx with glucose.
Frey syndrome after parotidectomy?
Gustatory sweating unilaterally when eating.
paras reinnervating sweat glands (starch iodine test). Tx: deodorant.
Reported excess body weight loss with lap band, sleeve, RNY? at 2, 1.5, and 1.5 years respectively
Band: 35-60%
Sleeve 45-60%
RYGB 60-75%
Recurrent Anal SCC?
APR.
Anterior component separation?
External oblique
Posterior component separation?
transversus abdominis
Baseline energy requirement.
25 Cal/day
Hodgkin lymphoma staging. I-IV
I. single site
II. 2+ sites above or below diaphragm
III. above & below
IV. involves nonlymphatic organs
Add a B (IIIB) if constitutional symptoms
Portal perfusion pressure estimated by what hepatic vein measurement?
Hepatic venous pressure gradient (portal = wedged HV pressure) and hepatic vein (transjugular I.e.)
Hepatic venous pressure gradient and clinical correlation?
<5 mm Hg normal
6-9 mm portal HTN clinically asx
10-12 varices
12+ variceal bleeding and ascites
pediatric inguinal hernia mgmt?
reduce, admit for 24-48 hours to decrease edema, operate.
CCK
I cells (small intestine)
Gastrin
G cells (antrum, duo)
Ghrelin
P/D1 cells, fundus
Glucagon
alpha cells, pancreas
Glucagon like peptide GLP
L cells, small and large intestine
Glucose dependent insulinotropic peptide GIP
Kcells, small intestine
Histamine
ECL and mast cells, stomach
Motilin
Mo cells, small intestine
Peptide YY
L cells, small and large intestine
Pancreatic polypeptide
PP, pancreas
Secretin
S cells, small intestine
Somatostatin
Delta cells, pancreas, stomach, intestine
Where is the cricopharyngeal/Killians triangle
between oblique fibers of thyropharyngeus and horitzontal fibers of the cricopharyngeus mm
Pulsion vs traction diverticulum in esophagus
Pulsion: FALSE - Zenker/epiphrenic
Traction: TRUE - mid esophagus (Histoplasmosis)
LIfespan of platelet? Albumin?
9 days, 21 days
Warfarin reversal
PCC (II, VII, IX, X); and give Vit K (12 hours to work, longer lasting)
FFP (has all factors fibrinogen, albmin, lytes, C/S/antithrombin, tissue factor) but larger volume
beztoluzumab
recurrent C diff with fidaxomicin
Urethral injuries graded by AAST I-V
I. contusion (Foley)
II. urethral stretch injury (Foley)
III. partial disruption (surgical alignment)
IV. complete disruption without separation (cystostomy)
V: extensive separation (cystostomy endoscopic realignment)
UES (15 cm cricopharyngeus)
LES (40 cm)
resting pressure?
UES: 50-70mm, 15 when swallowing
LES: 10-20mm, 0 when swallowing
Gastrin and motilin effect on LES
Increases
Kenalog in scars? MOA
Increase FGF (fibroblast growth), decrease transforming growth factor B1 production/VEGF, insulin like growth factor-1 (AKA decrease colagen)
preferred repair fo femoral hernia
McVay (mesh free) - conjoint (transv and internal) tendon suture to Coopers; with transition suture to incorporate sheving edge of inguinal ligament
carotid triangle superior border (separates from submandibular triangle)
digastric posterior belly
submandibular triangle vs submental triangle
digastric anterior belly
submental vs muscular triangle
hyoid bone
What do you monitor for dosing of heparin during vascular surgery
Activated clotting time
50-100 IU/kg cross clamping with ACT > 200.
bowen disease
actininc keratosis > bowel CIS (4-6 mm margin resectino) > SCC
GIST origin
interstitial cells of cajal; 90% have cKIT CD 117 mutation
anterior vagus
arises from plexus of R/L vagus; 2 DIVISIONS
hepatic division to liver and biliary
anterior gastric: (ant nerve of Latarjet) to ant stomach
posterior vagus
arises from plexus R/L vagus; 2 DIVISIONS
celiac division to plexus (parasympathetic inflow)
posterior gastric: (criminal nerve of grassi) to post stomach
mycophenalate mofetil SE
leukopenia
cyclosporine
renal, brain toxicity, gingival hyperplasia
azathioprine
myelotoxicity
sirolimus/everolimus SE
hypercholesterol, hyperTg, oral ulcer, proteinuria, thrombocytopenia
mafenide acetate / sulfamylon
metabolic acidosis
sulfadiazene ; silvadene
leukopenia
silver nitrate
methemaglobinemia
division during hepatectomy after chole & IOC; order of division
hepatic aa, portal vein, then bile duct
how to repair positive leak test during pyloromyotomy?
single layer, absorbable, transversely with omental patch
common gestation/development milestones
4th: esophagus/trach separation
6th: vagal innervation to esophagus, mucosal coating
7th: aortic blood to esophagus
9th muscular coating to esophagus
rectal prolapse surgical options
modified ripstein: mobilize intraabdominally secure mesh to presacral fascia and lateral rectum
altemeier: exteriorize through anus, full thickness incision and coloanal staple/handsewn
delorme: circumferential mucosal incision 1 cm above dentate, remove mucosa longitudinal plication of muscularis propria, anastomose mucosal edges
