ABSITE Flashcards
(97 cards)
1
Q
Ideal Body Weight Formula
A
Male = 50 kg + 2.3 kg for each inch >5' Female = 45.5 + 2.3 kg for each inch >5'
2
Q
refeeding syndrome
A
complication of aggressive nutrition support after prolonged starvation
3
Q
Components of TPN
A
Percentage of calories: 55% from dextrose 25-30% from lipids 20% from AAs (10-15% from essential AAs)
4
Q
Calories in TPN
A
1 mL TPN = 1 cal
5
Q
Essential FAs
A
linolenic, linoleic
6
Q
most common complication of TPN
A
line infection
7
Q
Which amino acids cannot act as precursors to gluconeogenesis
A
leonine and lysine
8
Q
zinc deficiency
A
skin rash, hair loss
9
Q
selenium deficiency
A
cardiomyopathy
10
Q
chromium deficiency
A
poor glycemic control
11
Q
copper deficiency
A
pancytopenia
12
Q
protein requirements for healthy adults
A
0.8g/kg/day
13
Q
protein requirements for critically ill surgical patients WITHOUT renal or hepatic disease
A
1.5-2.0g/kg/day
14
Q
Kwashiorkor
A
edema, anasarca, anorexia: “protein defecit”
15
Q
Marasmus
A
no edema. severe muscle wasting, loss of body fat: “total calorie defecit”
16
Q
In PPN, 50% of calories are from ___
A
lipids
17
Q
tx for symptomatic or severe hyponatremia (<100 mEq/L)
A
hypertonic saline
18
Q
presentation of hypercalcemic crisis
A
muscle weakness, fatigue, hypercalcemia
19
Q
tx of severe hypocalcemia
A
calcium gluconate or calcium chloride
20
Q
tx of non-severe hypocalcemia
A
PO calcium
21
Q
1st symptom of hypocalcemia
A
perioral or fingertip numbness
22
Q
Each __ mEq of potassium will raise serum K by __ mEq/L
A
Each 10 mEq of potassium will raise serum K by 0.1 mEq/L
23
Q
What is the chemical cause of metabolic alkalosis?
A
Loss of anions (e.g. Cl- from the stomach and albumin from plasma) or increases in cations (rare).
24
Q
Metabolic derangements in recurrent vomiting
A
hypokalemic, hypochloremic metabolic alkalosis with low urine Cl-
25
Tx for metabolic derangements of recurrent vomiting
Cl- replacement via NS
26
What causes paradoxical aciduria?
It presents in metabolic alkalosis 2/2 recurrent vomiting because of activation of H+/K+ exchanger to conserve K+.
27
What metabolic effects/derangements are associated with spironolactone?
potassium-sparing; hyperchloremic, non-anion gap metabolic acidosis
28
What are elemental formulas?
Easily digestible, low-fat nutrition that uses free amino acids or small chain peptides as protein sources for patients with maldigestion and malabsorption.
29
Formula for anion gap
Na - (Cl + HC03)
| cations minus anions
30
Normal anion gap
8 +/- 4
31
What are the causes of anion gap metabolic acidosis?
```
MUDPILES, SiR
M: methanol
U: uremia
D: DKA
P: propylene glycol
I: isoniazid
L: lactic acidosis
E: ethylene glycol
S: salicylates
S: sepsis
R: renal failure
```
32
What are the causes of non anion gap metabolic acidosis?
DR.
D: diarrhea
R: renal tubular acidosis
33
emergency tx of severe symptomatic hypermagnesemia
Calcium gluconate to antagonize the effect of magnesium on neuromuscular function. Can also give IVF and loop diuretics.
34
What cells rely on glucose as their exclusive fuel source?
RBCs
polymorph neutrophils
adrenal medulla
35
Heart muscles rely on ___ for fuel
free fatty acids
36
Skeletal muscles use ___ for fuel
glucose (but can use free fatty acids when stressed)
37
The brain uses ___ for fuel
glucose (but can use ketones in starvation)
38
What does the pancreas secrete in active forms?
amylase
lipase
ribonuclease
deoxyribonuclease
39
What is the function of pancreatic lipase?
It works at the oil/water interface to yield free fatty acids and monoacylglycerols
40
How are medium and short chain fatty acids absorbed? Where are they secreted?
by simple diffusion; into the portal venous circulation
41
How are long chain triglycerides metabolized?
They must undergo lipolysis into constituent LCFAs and MAGs by pancreatic and gastric lipases before being absorbed by the intestinal epithelium
42
What constitutes the majority of dietary fats?
Long chain triglycerides
43
LCFAs, MAGs, cholesterol, and fat soluble vitamins are all absorbed in ____.
micelles
44
___ help form micelles, but are not absorbed with them. They are absorbed by ___ in the ___.
bile salts; active transport; distal ileum
45
___ is the primary plasma carrier of cholesterol
low density lipoprotein
46
Where are bile salts produced? What conjugates them?
liver; glycine and taurine
47
What are examples of primary bile acids?
cholic acid and chenodeoxycholic acid
48
Where are primary bile acids synthesized?
in the liver, from cholesterol precursors
49
What are examples of secondary bile acids?
deoxycholic acid and lithocolic acid
50
How are secondary bile acids formed?
by deconjugation of primary bile acids by intestinal bacteria
51
half life of albumin
21 days
52
Strongest determinant of preoperative poor nutritional status
albumin
53
half life of pre-albumin
24-48 hours
54
half life of transferrin
8 days
55
What is transferrin and how does it change during acute inflammatory conditions?
main plasma transport protein of iron; decreases during acute inflammatory conditions
56
___ is the strongest determinant of serum osmolarity
sodium
57
Formula for serum osmolarity
Osm = 2Na + Glu/18 + Urea/2.8
58
basal energy expenditure (and modification for pregnancy)
25 kcal/kg/day (in pregnancy add 300 kcal/day)
59
What is the precursor to urea? What enzyme makes that transition?
arginine; arginase
60
Where is urea produced?
liver
61
Where is urea excreted?
kidney
62
What is the expected excess weight loss 2 years following sleeve gastrectomy?
approximately 60%
63
What is the presentation of ABO incompatibility? How does it progress?
tender, erythematous IV site; chest pain; hypotension
| can progress to hemoglobinuria and DIC
64
What is the most common blood product to contain a bacterial contaminant? Why?
platelets, because they are stored at room temperature
65
What is the most common contaminant of platelets?
gram negative rods (most commonly E. coli)
66
Actinic keratosis is a risk factor for ___.
squamous cell cancer
67
___ (aka factor ___) cleaves fibrinogen to form fibrin
thrombin; IIa
68
What does thrombin activate?
factor V, VIII, and platelets
69
What are the components of a platelet plug?
platelets and fibrin
70
hemophilia A & B are deficiencies in ___ and ___; and have ___ PT/bleeding time and ___ PTT
hemophilia A: deficiency in VIII
hemophilia B: deficiency in IX
normal PT/bleeding time
elevated PTT
71
Acute tx for hemophilia A&B
Factor VIII concentrate or cryoprecipitate
72
What is the most common congenital bleeding disorder?
von Willibrand disease
73
von Willibrand disease has ___ BT and low ___ and ___
prolonged BTT
| low vWF and factor VIII
74
What cell types produce von Willibrand factor?
endothelial cells and megakaryocytes
75
What is Von Hippel Lindau syndrome?
```
hemangiomas of CNS and retina
pheochromocytoma
clear cell renal cell cancer
endolymphatic sac tumors
cystadenomas of the epididymis and broad ligament
```
76
What is the screening for Von Hippel Lindau syndrome? How often does it occur?
```
annual screening:
urine cytology
ophtho exams
renal ultrasound
24 hr urine for VMA and metanephrine
```
77
What is caused by the PTEN mutation?
Cowden syndrome
78
What is caused by the MLH1 mutation?
Lynch syndrome (hereditary nonpolyposis colorectal cancer)
79
What is caused by the MSH2 mutation?
Lynch syndrome (hereditary nonpolyposis colorectal cancer)
80
What is caused by the MSH6 mutation?
Lynch syndrome (hereditary nonpolyposis colorectal cancer)
81
What is caused by the PMS2 mutation?
Lynch syndrome (hereditary nonpolyposis colorectal cancer)
82
What are the most important predictors of poor outcome in melanoma?
lymph node involvement and distant mets
83
What procedure must be done before operating on head/neck/trunk melanoma?
preop lymphatic mapping of all possible nodal basins
84
What is the most powerful predictor of melanoma prognosis?
melanoma depth
85
___ is an FDA approved adjuvant tx following resection of stage IIb-III melanoma.
interferon alpha 2b
86
Melanoma: < 1mm
T1 melanoma lesions
87
Melanoma: 1.01-2mm
T2 melanoma lesions
88
Melanoma: 2.01-4mm
T3 melanoma lesions
89
What's the difference between "a" and "b" in melanoma T staging?
"a" is without ulceration
"b" is with ulceration
(b for bad)
90
Melanoma involving 1 lymph node
N1 melanoma
91
Melanoma involving 2-3 regional lymph nodes
N2 melanoma
92
Melanoma involving 4+ regional lymph nodes
N3 melanoma
93
Melanoma without metastasis
M0 melanoma
94
Melanoma with mets to skin, subQ, or distant lymph nodes, normal LDH
M1a melanoma
95
Melanoma with lung mets, normal LDH
M1b melanoma
96
Melanoma with mets to viscera other than lungs with normal LDH or any distant mets + elevated LDH
M1c melanoma
97
Thrombotic thrombocytopenic purpura pentad
```
fever
AMS
hemolytic anemia
renal failure/hematuria
purpura
```
